TY - JOUR
T1 - Risk factors of acromial and scapular spine stress fractures differ by indication
T2 - a study by the ASES Complications of Reverse Shoulder Arthroplasty Multicenter Research Group
AU - ASES Complications of RSA Research Group:
AU - Lohre, Ryan
AU - Swanson, Daniel P.
AU - Mahendraraj, Kuhan A.
AU - Elmallah, Randa
AU - Glass, Evan A.
AU - Dunn, Warren R.
AU - Cannon, Dylan J.
AU - Friedman, Lisa GM
AU - Gaudette, Jaina A.
AU - Green, John
AU - Grobaty, Lauren
AU - Gutman, Michael
AU - Kakalecik, Jaquelyn
AU - Kloby, Michael A.
AU - Konrade, Elliot N.
AU - Knack, Margaret C.
AU - Loveland, Amy
AU - Mathew, Joshua I.
AU - Myhre, Luke
AU - Nyfeler, Jacob
AU - Parsell, Doug E.
AU - Pazik, Marissa
AU - Polisetty, Teja S.
AU - Ponnuru, Padmavathi
AU - Smith, Karch M.
AU - Sprengel, Katherine A.
AU - Thakar, Ocean
AU - Turnbull, Lacie
AU - Vaughan, Alayna
AU - Wheelwright, John C.
AU - Abboud, Joseph
AU - Armstrong, April
AU - Austin, Luke
AU - Brolin, Tyler
AU - Entezari, Vahid
AU - Garrigues, Grant E.
AU - Grawe, Brian
AU - Gulotta, Lawrence V.
AU - Hobgood, Rhett
AU - Horneff, John G.
AU - Iannotti, Joseph
AU - Khazzam, Michael
AU - King, Joseph J.
AU - Kirsch, Jacob M.
AU - Levy, Jonathan C.
AU - Murthi, Anand
AU - Namdari, Surena
AU - Nicholson, Gregory P.
AU - Otto, Randall J.
AU - Ricchetti, Eric T.
N1 - Publisher Copyright:
© 2023 Journal of Shoulder and Elbow Surgery Board of Trustees
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - Acromial stress fracture
KW - Level III
KW - Prognosis Study
KW - Retrospective Case-Control Design
KW - delphi process
KW - multicenter
KW - reverse shoulder arthroplasty
KW - risk factors
KW - scapular spine stress fracture
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U2 - 10.1016/j.jse.2023.05.015
DO - 10.1016/j.jse.2023.05.015
M3 - Article
C2 - 37330167
AN - SCOPUS:85169512596
SN - 1058-2746
VL - 32
SP - 2483
EP - 2492
JO - Journal of Shoulder and Elbow Surgery
JF - Journal of Shoulder and Elbow Surgery
IS - 12
ER -