Should the Supraspinatus Tendon Be Excised in the Case of Reverse Shoulder Arthroplasty for Fracture?

Overview

Journal Eur J Orthop Surg Traumatol

Specialty Orthopedics

Date 2019 Oct 6

PMID 31586235

Citations 6

Authors

Nicolas Bonnevialle

Xavier Ohl

Philippe Clavert

Luc Favard

Anne Fregeac

Laurent Obert

Christophe Chantelot

David Gallinet

Pascal Boileau

Affiliations

Soon will be listed here.

Abstract

Purpose: In the case of reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs) with tuberosity reconstruction, it is unclear whether the supraspinatus tendon continues to play a role. The aim of this study was to evaluate the clinical and radiological outcomes of RSA for PHFs in a large cohort of elderly patients and compare the results in the case of supraspinatus excision or preservation.

Methods: In this retrospective multicentre study, 150 patients (mean age 77 years, 93% female) were reviewed and radiographed with a minimum follow-up of 24 months. The same Grammont prosthetic design was used in all cases (inclination angle 155°, non-lateralised glenosphere). Patients were divided into two groups: Group A (n = 117) underwent supraspinatus excision and Group B supraspinatus preservation (n = 33). Complications were recorded, and shoulder function, active mobility and subjective results were assessed.

Results: At a mean follow-up of 59 months, there was no statistical difference in the complication rate (6% vs. 6.8%, p = 1), mean Constant score (61 points vs. 59 points, p = 0.52), simple shoulder value (74% vs. 73.9%, p = 0.9), active anterior elevation (125° vs. 128°, p = 0.45) and internal rotation (4.9 points vs. 4.1 points, p = 0.2). However, mean active external rotation was better in Group A (22° vs. 13°, p = 0.01). The greater tuberosity healing rate in satisfactory position did not differ statistically between the groups (68% vs. 55%, p = 0.14).

Conclusion: In the case of RSA with tuberosity reconstruction for acute PHFs, there is no clear evidence that supraspinatus preservation is advantageous.

Citing Articles

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References

Levigne C, Garret J, Boileau P, Alami G, Favard L, Walch G . Scapular notching in reverse shoulder arthroplasty: is it important to avoid it and how?. Clin Orthop Relat Res. 2010; 469(9):2512-20. PMC: 3148391. DOI: 10.1007/s11999-010-1695-8. View

Muller A, Born M, Jung C, Flury M, Kolling C, Schwyzer H . Glenosphere size in reverse shoulder arthroplasty: is larger better for external rotation and abduction strength?. J Shoulder Elbow Surg. 2017; 27(1):44-52. DOI: 10.1016/j.jse.2017.06.002. View

Ross M, Hope B, Stokes A, Peters S, McLeod I, Duke P . Reverse shoulder arthroplasty for the treatment of three-part and four-part proximal humeral fractures in the elderly. J Shoulder Elbow Surg. 2014; 24(2):215-22. DOI: 10.1016/j.jse.2014.05.022. View

Cazeneuve J, Cristofari D . Long term functional outcome following reverse shoulder arthroplasty in the elderly. Orthop Traumatol Surg Res. 2011; 97(6):583-9. DOI: 10.1016/j.otsr.2011.03.025. View

Lignel A, Berhouet J, Loirat M, Collin P, Thomazeau H, Gallinet D . Reverse shoulder arthroplasty for proximal humerus fractures: Is the glenoid implant problematic?. Orthop Traumatol Surg Res. 2018; 104(6):773-777. DOI: 10.1016/j.otsr.2018.06.008. View

Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D . Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br. 2004; 86(3):388-95. DOI: 10.1302/0301-620x.86b3.14024. View

Mollon B, Mahure S, Roche C, Zuckerman J . Impact of glenosphere size on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 297 shoulders. J Shoulder Elbow Surg. 2016; 25(5):763-71. DOI: 10.1016/j.jse.2015.10.027. View

Chun Y, Kim D, Lee D, Shin S . Reverse shoulder arthroplasty for four-part proximal humerus fracture in elderly patients: can a healed tuberosity improve the functional outcomes?. J Shoulder Elbow Surg. 2017; 26(7):1216-1221. DOI: 10.1016/j.jse.2016.11.034. View

Sirveaux F, Roche O, Mole D . Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res. 2010; 96(6):683-94. DOI: 10.1016/j.otsr.2010.07.001. View

10.

Gilbart M, Gerber C . Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg. 2007; 16(6):717-21. DOI: 10.1016/j.jse.2007.02.123. View

11.

Ohl X, Bonnevialle N, Gallinet D, Ramdane N, Valenti P, Decroocq L . How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures. J Shoulder Elbow Surg. 2018; 27(12):2139-2144. DOI: 10.1016/j.jse.2018.05.030. View

12.

Boileau P, Krishnan S, Tinsi L, Walch G, Coste J, Mole D . Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002; 11(5):401-12. DOI: 10.1067/mse.2002.124527. View

13.

Berhouet J, Garaud P, Favard L . Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: a cadaver study. Orthop Traumatol Surg Res. 2013; 99(8):887-94. DOI: 10.1016/j.otsr.2013.08.008. View

14.

Florschutz A, Lane P, Crosby L . Infection after primary anatomic versus primary reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2015; 24(8):1296-301. DOI: 10.1016/j.jse.2014.12.036. View

15.

Chen L, Xing F, Xiang Z . Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review. PLoS One. 2016; 11(11):e0166801. PMC: 5115806. DOI: 10.1371/journal.pone.0166801. View

16.

Bacle G, Nove-Josserand L, Garaud P, Walch G . Long-Term Outcomes of Reverse Total Shoulder Arthroplasty: A Follow-up of a Previous Study. J Bone Joint Surg Am. 2017; 99(6):454-461. DOI: 10.2106/JBJS.16.00223. View

17.

Constant C, Gerber C, Emery R, Sojbjerg J, Gohlke F, Boileau P . A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008; 17(2):355-61. DOI: 10.1016/j.jse.2007.06.022. View

18.

Boileau P, Watkinson D, Hatzidakis A, Hovorka I . Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006; 15(5):527-40. DOI: 10.1016/j.jse.2006.01.003. View

19.

Anakwenze O, Zoller S, Ahmad C, Levine W . Reverse shoulder arthroplasty for acute proximal humerus fractures: a systematic review. J Shoulder Elbow Surg. 2014; 23(4):e73-80. DOI: 10.1016/j.jse.2013.09.012. View

20.

Gallinet D, Adam A, Gasse N, Rochet S, Obert L . Improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 22(1):38-44. DOI: 10.1016/j.jse.2012.03.011. View