Radiological Bony Lesions of the Lateral Proximal Humeral Cortex following Reverse Shoulder Arthroplasty Associated with Latissimus-Dorsi\Teres-Major Transfer: Is the Clinical Outcome Affected?
2Orthopedic Devision, Tel-Aviv Sourasky Medical Center, Israel
Background:
Reverse total shoulder arthroplasty (RSA) associated with modified L’Episcopo (isolated LD) or L’Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with posterosuperior massive cuff tear and malfunctioning teres minor. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome.
Material and Methods:
A retrospective review of24 RSAs (mean age 68.71 years, range 52-83) associated with modified L’Episcopo procedure(9) and L’Episcopo procedure(15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores.
Results:
With a mean follow-up of 44.71 months (12-97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3 %) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 78% of cementless stems. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group2, 16 patients) and without bony lesions (Group1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34).
Conclusion:
At short-term follow-up, RSA combined with tendon transfer resulted in high incidence (67%) of lateral proximal humerus lesions. However, no humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of straight standard length cemented humeral stems should be positively considered in RSA associated with LD\TM tendon transfer. The use of non-cemented short straight or stemless humeral implants, with their potentially bone preserving effect, could be equally considered.