Bone Density Changes at the Origin of the Deltoid Muscle Following Reverse Shoulder Arthroplasty

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Jul 13

PMID 38999260

Authors

Antonio Caldaria

Edoardo Giovannetti de Sanctis

Luca Saccone

Angelo Baldari

Danila Azzolina

Luca La Verde

Alessio Palumbo

Francesco Franceschi

Affiliations

Soon will be listed here.

Abstract

Reverse total shoulder arthroplasty (RSA) significantly impacts deltoid length, tension, and structure. Studies have extensively investigated various modifications in deltoid characteristics, such as perfusion, elasticity, caliber, histological changes, and strength post-RSA. However, to date, there is a notable absence of research evaluating changes in bone mineral density (BMD) at the deltoid muscle origin after the RSA procedure. A retrospective analysis of a consecutive series of RSAs performed between May 2011 and May 2022 was conducted. Inclusion criteria comprised primary RSAs with both preoperative and last follow-up shoulder CT scans and a minimum follow-up of 12 months. Trabecular attenuation measured in Hounsfield units (HU) was calculated using a rapid region-of-interest (ROI) method. BMD analysis involved segmenting three ROIs in both pre- and postoperative CT scans of each patient: the acromion, clavicle, and spine of the scapula. A total of 44 RSAs in 43 patients, comprising 29 women and 14 men, were included in this study. The mean follow-up duration was 49 ± 22.64 months. Significant differences were observed between preoperative and postoperative HU values in all analyzed regions. Specifically, BMD increased in the acromion and spine, while it decreased in the clavicle (-values 0.0019, <0.0001, and 0.0088, respectively). The modifications in shoulder biomechanics and, consequently, deltoid tension post-implantation result in discernible variations in bone quality within the analyzed regions. This study underscores the importance of thorough preoperative patient planning. By utilizing CT images routinely obtained before reverse shoulder replacement surgery, patients at high risk for fractures of the acromion, clavicle, and scapular spine can be identified.

References

Liu G, Li L, Yang C, Wei L, Li T, Zhu L . Hounsfield units predicts the occurrence but not the patterns of proximal humerus fracture in the elderly patients. BMC Musculoskelet Disord. 2023; 24(1):342. PMC: 10155427. DOI: 10.1186/s12891-023-06442-6. View

Greiner S, Back D, Herrmann S, Perka C, Asbach P . Degenerative changes of the deltoid muscle have impact on clinical outcome after reversed total shoulder arthroplasty. Arch Orthop Trauma Surg. 2009; 130(2):177-83. DOI: 10.1007/s00402-009-1001-y. View

Koch M, Schmidt C, Kerschbaum M, Winkler T, Pfeifer C, Greiner S . Reversed shoulder arthroplasty leads to significant histological changes of the deltoid muscle: a prospective intervention trial. Arch Orthop Trauma Surg. 2020; 141(7):1149-1154. PMC: 8215043. DOI: 10.1007/s00402-020-03503-6. View

Soma D, Ichiseki T, Ueda S, Sakurai M, Kawahara N . Radiographic Evaluation and Changes in Bone Density of the Humeral Side after Reverse Total Shoulder Arthroplasty. J Clin Med. 2023; 12(24). PMC: 10743489. DOI: 10.3390/jcm12247698. View

Moser T, Lecours J, Michaud J, Bureau N, Guillin R, Cardinal E . The deltoid, a forgotten muscle of the shoulder. Skeletal Radiol. 2013; 42(10):1361-75. DOI: 10.1007/s00256-013-1667-7. View

Fischer C, Flammer S, Kauczor H, Zeifang F, Schmidmaier G, Kunz P . Preoperative deltoid assessment by contrast-enhanced ultrasound (CEUS) as predictor for shoulder function after reverse shoulder arthroplasty: a prospective pilot study. Arch Orthop Trauma Surg. 2019; 140(8):1001-1012. DOI: 10.1007/s00402-019-03281-w. View

Giles J, Langohr G, Johnson J, Athwal G . Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load. Clin Orthop Relat Res. 2015; 473(11):3615-26. PMC: 4586233. DOI: 10.1007/s11999-015-4526-0. View

Hayden A, Cotter E, Hennick T, Hetzel S, Wollaeger J, Anderson S . Bone quality in total shoulder arthroplasty: a prospective study correlating computed tomography Hounsfield units with thumb test and fracture risk assessment tool score. JSES Int. 2023; 7(4):628-635. PMC: 10328770. DOI: 10.1016/j.jseint.2023.03.012. View

Walker D, Struk A, Matsuki K, Wright T, Banks S . How do deltoid muscle moment arms change after reverse total shoulder arthroplasty?. J Shoulder Elbow Surg. 2015; 25(4):581-8. DOI: 10.1016/j.jse.2015.09.015. View

10.

Fenwick A, Reichel T, Eden L, Schmalzl J, Meffert R, Plumhoff P . Deltoid Muscle Tension Alterations Post Reverse Shoulder Arthroplasty: An Investigation Using Shear Wave Elastography. J Clin Med. 2023; 12(19). PMC: 10573934. DOI: 10.3390/jcm12196184. View

11.

Levin J, Rodriguez K, Polascik B, Zeng S, Warren Jr E, Rechenmacher A . Simple preoperative radiographic and computed tomography measurements predict adequate bone quality for stemless total shoulder arthroplasty. J Shoulder Elbow Surg. 2022; 31(12):2481-2487. DOI: 10.1016/j.jse.2022.05.008. View

12.

Ehrlich J, Vendries V, Bryant T, Rainbow M, Ploeg H, Bicknell R . Trabecular bone density distribution in the scapula of patients undergoing reverse shoulder arthroplasty. JSES Int. 2022; 6(1):32-39. PMC: 8811382. DOI: 10.1016/j.jseint.2021.09.004. View

13.

Yeazell S, Inacio J, Malige A, Dailey H, Carolan G . Bone density and its relation to the development of acromial stress fracture following reverse total shoulder arthroplasty. Shoulder Elbow. 2022; 14(2):135-141. PMC: 8899318. DOI: 10.1177/1758573220949992. View

14.

Costantini O, Choi D, Kontaxis A, Gulotta L . The effects of progressive lateralization of the joint center of rotation of reverse total shoulder implants. J Shoulder Elbow Surg. 2015; 24(7):1120-8. DOI: 10.1016/j.jse.2014.11.040. View

15.

Razi T, Niknami M, Alavi Ghazani F . Relationship between Hounsfield Unit in CT Scan and Gray Scale in CBCT. J Dent Res Dent Clin Dent Prospects. 2014; 8(2):107-10. PMC: 4120902. DOI: 10.5681/joddd.2014.019. View

16.

Patterson D, Chi D, Parsons B, Cagle Jr P . Acromial spine fracture after reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2018; 28(4):792-801. DOI: 10.1016/j.jse.2018.08.033. View

17.

Gerber C, Canonica S, Catanzaro S, Ernstbrunner L . Longitudinal observational study of reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction: results after 15 years. J Shoulder Elbow Surg. 2018; 27(5):831-838. DOI: 10.1016/j.jse.2017.10.037. View

18.

Herrmann M, Engelke K, Ebert R, Muller-Deubert S, Rudert M, Ziouti F . Interactions between Muscle and Bone-Where Physics Meets Biology. Biomolecules. 2020; 10(3). PMC: 7175139. DOI: 10.3390/biom10030432. View

19.

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

20.

Agostini D, Zeppa Donati S, Lucertini F, Annibalini G, Gervasi M, Ferri Marini C . Muscle and Bone Health in Postmenopausal Women: Role of Protein and Vitamin D Supplementation Combined with Exercise Training. Nutrients. 2018; 10(8). PMC: 6116194. DOI: 10.3390/nu10081103. View