Risk factors of acromial and scapular spine stress fractures differ by indication: a study by the ASES Complications of Reverse Shoulder Arthroplasty Multicenter Research Group

被引：5

作者：

Lohre, Ryan ^{[1
]}

Swanson, Daniel P. ^{[2
]}

Mahendraraj, Kuhan A. ^{[2
]}

Elmallah, Randa ^{[2
]}

Glass, Evan A. ^{[2
]}

Dunn, Warren R. ^{[3
]}

Cannon, Dylan J. ^{[4
]}

Friedman, Lisa GM. ^{[5
]}

Gaudette, Jaina A. ^{[5
]}

Green, John ^{[6
]}

Grobaty, Lauren ^{[7
]}

Gutman, Michael ^{[8
]}

Kakalecik, Jaquelyn ^{[9
,10
]}

Kloby, Michael A. ^{[11
]}

Konrade, Elliot N. ^{[12
]}

Knack, Margaret C. ^{[12
]}

Loveland, Amy ^{[13
]}

Mathew, Joshua I. ^{[14
]}

Myhre, Luke ^{[15
]}

Nyfeler, Jacob ^{[15
]}

Parsell, Doug E. ^{[16
]}

Pazik, Marissa ^{[10
]}

Polisetty, Teja S. ^{[4
]}

Ponnuru, Padmavathi ^{[17
]}

Smith, Karch M.

Sprengel, Katherine A. ^{[5
]}

Thakar, Ocean ^{[13
]}

Turnbull, Lacie ^{[10
]}

Vaughan, Alayna ^{[8
]}

Wheelwright, John C.

Abboud, Joseph ^{[8
]}

Armstrong, April ^{[17
]}

Austin, Luke ^{[9
]}

Brolin, Tyler

Entezari, Vahid

Garrigues, Grant E.

Grawe, Brian ^{[11
]}

Gulotta, Lawrence V. ^{[14
]}

Hobgood, Rhett ^{[16
]}

Horneff, John G.

Iannotti, Joseph

Khazzam, Michael ^{[18
]}

King, Joseph J. ^{[10
]}

Kirsch, Jacob M. ^{[2
]}

Levy, Jonathan C. ^{[19
]}

Murthi, Anand ^{[13
]}

Namdari, Surena ^{[9
]}

Nicholson, Gregory P.

Otto, Randall J. ^{[6
]}

Ricchetti, Eric T. ^{[7
]}

机构：

[1] Harvard Med Sch, Boston Shoulder Inst, Massachusetts Gen Hosp, Dept Orthopaed Surg, Boston, MA USA

[2] New England Baptist Hosp, Dept Orthopaed Surg, Boston, MA USA

[3] Fondren Orthopaed Grp, Orthopaed Surg, Houston, TX USA

[4] Holy Cross Orthoped Inst, Ft Lauderdale, FL USA

[5] Rush Univ, Med Ctr, Midwest Orthopaed Rush, Chicago, IL USA

[6] St Louis Univ, Sch Med, Dept Orthopaed Surg, St Louis, MO USA

[7] Cleveland Clin, Dept Orthopaed Surg, Cleveland, OH USA

[8] Rothman Orthopaed Inst, Philadelphia, PA USA

[9] Univ Florida, Coll Med, Dept Orthopaed Surg & Sports Med, Gainesville, FL USA

[10] Univ Cincinnati, Coll Med, Cincinnati, OH USA

[11] Univ Tennessee Hlth Sci Ctr, Campbell Clin, Dept Orthopaed Surg & Biomed Engn, Knoxville, TN USA

[12] MedStar Union Mem Hosp, Baltimore, MD USA

[13] Hosp Special Surg, New York, NY USA

[14] Univ Utah, Sch Med, Salt Lake City, UT USA

[15] Mississippi Sports Med & Orthopaed Ctr, Jackson, MS USA

[16] Penn State Bone & Joint Inst, Hershey, PA USA

[17] Univ Penn, Philadelphia, PA USA

[18] UT Southwestern Med Ctr, Dallas, TX USA

[19] Paley Orthoped & Spine Inst, Levy Shoulder Ctr, Boca Raton, FL USA

[20] 840 Winter St, Waltham, MA 02451 USA

来源：

JOURNAL OF SHOULDER AND ELBOW SURGERY | 2023年 / 32卷 / 12期

关键词：

Acromial stress fracture; scapular spine stress fracture; reverse shoulder arthroplasty; multicenter; risk factors; delphi process; RHEUMATOID-ARTHRITIS;

D O I：

10.1016/j.jse.2023.05.015

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Background: Both patient and implant related variables have been implicated in the incidence of acromial (ASF) and scapular spine fractures (SSF) following reverse shoulder arthroplasty (RSA); however, previous studies have not characterized nor differentiated risk profiles for varying indications including primary glenohumeral arthritis with intact rotator cuff (GHOA), rotator cuff arthropathy (CTA), and massive irreparable rotator cuff tear (MCT). The purpose of this study was to determine patient factors predictive of cumulative ASF/SSF risk for varying preoperative diagnosis and rotator cuff status.Methods: Patients consecutively receiving RSA between January 2013 and June 2019 from 15 institutions comprising 24 members of the American Shoulder and Elbow Surgeons (ASES) with primary, preoperative diagnoses of GHOA, CTA and MCT were included for study. Inclusion criteria, definitions, and inclusion of patient factors in a multivariate model to predict cumulative risk of ASF/SSF were determined through an iterative Delphi process. The CTA and MCT groups were combined for analysis. Consensus was defined as greater than 75% agreement amongst contributors. Only ASF/SSF confirmed by clinical and radiographic correlation were included for analysis.Results: Our study cohort included 4764 patients with preoperative diagnoses of GHOA, CTA, or MCT with minimum follow-up of 3 months (range: 3-84). The incidence of cumulative stress fracture was 4.1% (n = 196). The incidence of stress fracture in the GHOA cohort was 2.1% (n = 34/1637) compared to 5.2% (n = 162/3127) (P < .001) in the CTA/MCT cohort. Presence of inflammatory arthritis (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.08-7.78; P = .035) was the sole predictive factor of stress fractures in GHOA, compared with inflammatory arthritis (OR 1.86, 95% CI 1.19-2.89; P = .016), female sex (OR 1.81, 95% CI 1.20-2.72; P = .007), and osteoporosis (OR 1.56, 95% CI 1.02-2.37; P = .003) in the CTA/MCT cohort.Conclusion: Preoperative diagnosis of GHOA has a different risk profile for developing stress fractures after RSA than patients with CTA/MCT. Though rotator cuff integrity is likely protective against ASF/SSF, approximately 1/46 patients receiving RSA with primary GHOA will have this complication, primarily influenced by a history of inflammatory arthritis. Understanding risk profiles of patients undergoing RSA by varying diagnosis is important in counseling, expectation management, and treatment by surgeons.

引用

页码：2483 / 2492

页数：10

共 22 条

[21] Complications after surgical treatment of proximal humerus fractures in the elderly-an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating
Klug, Alexander
Wincheringer, Dennis
Harth, Jasmin
Schmidt-Horlohe, Kay
Hoffmann, Reinhard
Gramlich, Yves
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2019, 28 (09) : 1674 - 1684
[22] Concomitant open distal clavicle excision is associated with greater improvement in range of motion without increased risk of acromial stress fracture after reverse total shoulder arthroplasty: a retrospective cohort study
Kanakamedala, Ajay C.
Shankar, Dhruv S.
Gambhir, Neil
Boylan, Matthew R.
Boin, Michael
Alben, Matthew G.
Virk, Mandeep S.
Kwon, Young W.
CLINICS IN SHOULDER AND ELBOW, 2023, 26 (04): : 357 - 365

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