Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis
Introduction Lesser tuberosity osteotomy (LTO) is an attractive option for subscapularis management during anatomic shoulder arthroplasty due to the biomechanical strength and reliable bone-to-bone healing. Patients with humeral head avascular necrosis (AVN) may have compromised bone healing, and th...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2018-05-01
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| Series: | Journal of Shoulder and Elbow Arthroplasty |
| Online Access: | https://doi.org/10.1177/2471549218778446 |
| _version_ | 1828451092538589184 |
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| author | Stephen P Maier BA Cesar D Lopez BS Zachary J Bloom MD Brian B Shiu MD Djuro Petkovic MD William N Levine MD Charles M Jobin MD |
| author_facet | Stephen P Maier BA Cesar D Lopez BS Zachary J Bloom MD Brian B Shiu MD Djuro Petkovic MD William N Levine MD Charles M Jobin MD |
| author_sort | Stephen P Maier BA |
| collection | DOAJ |
| description | Introduction Lesser tuberosity osteotomy (LTO) is an attractive option for subscapularis management during anatomic shoulder arthroplasty due to the biomechanical strength and reliable bone-to-bone healing. Patients with humeral head avascular necrosis (AVN) may have compromised bone healing, and the outcomes of LTO during AVN are unknown. Methods A retrospective consecutive case series of 6 patients with Cruess grade 4 or 5 humeral head AVN who underwent anatomic shoulder arthroplasty with LTO from 2010 to 2016 was performed. Postoperative radiographic evaluation for LTO healing at 6 months was analyzed, and clinical outcomes at latest follow-up, including range of motion (ROM), strength, and pain were studied.> Results Average age was 50.3 years. AVN was secondary to sickle cell in 1 patient, steroid use for systemic lupus erythematosus in 4, and chronic alcoholism in 1. By 6 months after arthroplasty, 100% had radiographically united and healed LTO. Patients averaged 140 ± 21° of active forward elevation and 42 ± 7° of active external rotation. Patients reported an improvement in visual analogue scale pain from 8.3 preoperatively to 3.8 postoperatively. All patients had a normal abdominal compression test. No patients required revision surgery. Conclusion The use of LTO during anatomic shoulder arthroplasty for AVN has an excellent bony healing rate with improvements in pain, ROM, and strength. The diseases that cause humeral head AVN do not negatively influence LTO healing outcomes during anatomic shoulder replacement. Level of Evidence IV Case Series |
| first_indexed | 2024-12-10T23:30:57Z |
| format | Article |
| id | doaj.art-9056ed857b214c279de675833d5f77f8 |
| institution | Directory Open Access Journal |
| issn | 2471-5492 |
| language | English |
| last_indexed | 2024-12-10T23:30:57Z |
| publishDate | 2018-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Shoulder and Elbow Arthroplasty |
| spelling | doaj.art-9056ed857b214c279de675833d5f77f82022-12-22T01:29:23ZengSAGE PublishingJournal of Shoulder and Elbow Arthroplasty2471-54922018-05-01210.1177/2471549218778446Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular NecrosisStephen P Maier BACesar D Lopez BSZachary J Bloom MDBrian B Shiu MDDjuro Petkovic MDWilliam N Levine MDCharles M Jobin MDIntroduction Lesser tuberosity osteotomy (LTO) is an attractive option for subscapularis management during anatomic shoulder arthroplasty due to the biomechanical strength and reliable bone-to-bone healing. Patients with humeral head avascular necrosis (AVN) may have compromised bone healing, and the outcomes of LTO during AVN are unknown. Methods A retrospective consecutive case series of 6 patients with Cruess grade 4 or 5 humeral head AVN who underwent anatomic shoulder arthroplasty with LTO from 2010 to 2016 was performed. Postoperative radiographic evaluation for LTO healing at 6 months was analyzed, and clinical outcomes at latest follow-up, including range of motion (ROM), strength, and pain were studied.> Results Average age was 50.3 years. AVN was secondary to sickle cell in 1 patient, steroid use for systemic lupus erythematosus in 4, and chronic alcoholism in 1. By 6 months after arthroplasty, 100% had radiographically united and healed LTO. Patients averaged 140 ± 21° of active forward elevation and 42 ± 7° of active external rotation. Patients reported an improvement in visual analogue scale pain from 8.3 preoperatively to 3.8 postoperatively. All patients had a normal abdominal compression test. No patients required revision surgery. Conclusion The use of LTO during anatomic shoulder arthroplasty for AVN has an excellent bony healing rate with improvements in pain, ROM, and strength. The diseases that cause humeral head AVN do not negatively influence LTO healing outcomes during anatomic shoulder replacement. Level of Evidence IV Case Serieshttps://doi.org/10.1177/2471549218778446 |
| spellingShingle | Stephen P Maier BA Cesar D Lopez BS Zachary J Bloom MD Brian B Shiu MD Djuro Petkovic MD William N Levine MD Charles M Jobin MD Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis Journal of Shoulder and Elbow Arthroplasty |
| title | Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis |
| title_full | Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis |
| title_fullStr | Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis |
| title_full_unstemmed | Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis |
| title_short | Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis |
| title_sort | lesser tuberosity osteotomy outcomes after anatomic shoulder arthroplasty in patients with atraumatic avascular necrosis |
| url | https://doi.org/10.1177/2471549218778446 |
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