Rheumatoid arthritis is associated with increased symptomatic acromial and scapular spine stress fracture after reverse total shoulder arthroplasty

Abstract

Background The purpose of this study was to determine factors associated with early symptomatic acromial and scapular spine fractures in patients who underwent reverse total shoulder arthroplasty (RTSA). Methods We retrospectively evaluated all RTSAs performed by the senior author between 1/1/2013 and 6/1/2019. We evaluated patient demographics including gender, age, prevalence of comorbidities including osteoporosis, inflammatory arthritis, diabetes, and endocrine disorders such as hypothyroidism. We also evaluated preoperative and 2-week postoperative radiographs for center of rotation medialization (CORM) as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance (AGT). We evaluated inter- and intra-rater reliability via intraclass correlation coefficients. Results We included 335 RTSAs with a minimum of 3 months of follow-up in the analysis. Reliability was acceptable with all intraclass correlation coefficients> 0.75. Symptomatic acromial and scapular spine stress fractures were significantly more common in those with inflammatory arthritis than those without (18% vs. 5%, P = 0.016). The rate of fracture was highest in patients with rheumatoid arthritis (24% vs. 5.2%, P = 0.003). There was no statistically significant association between symptomatic fractures and preoperative CORM or AGT ( P = 0.557, P = 0.528) or postoperative CORM or AGT ( P = 0.56, P = 0.102). There also was no statistically significant correlation between symptomatic stress fracture and patient age, gender, BMI, smoking, osteoporosis, gout, medical comorbidity, or previous shoulder surgery. Conclusion In this retrospective analysis of postoperative RTSA, symptomatic acromial and scapular stress fractures were significantly more common in patients with rheumatoid arthritis and thus precautions should be taken in these patients.

Effect of glenosphere lateralization with and without coracoacromial ligament transection on acromial and scapular spine strain in reverse shoulder arthroplasty

“… 12 , 15 , 21 Rheumatological disorders such as RA have shown to increase the risk of acromial stress fracture. 14 All these factors which may differ between the specimens used in the present study and that of Taylor et al may affect how the CAL contributes to acromial and scapular spine strain. Additionally, while our methods were modeled on the prior work of Taylor et al, 18 a minor difference in scapulothoracic motion exists between the shoulder model used in our biomechanics lab and the model used in their study.…”

Rotator cuff repair in patients with inflammatory arthritis: satisfactory midterm outcomes

“…Importantly, there is evidence that RA is associated with a higher risk of postoperative infection after primary RSA, 15 in addition to the literature demonstrating an increased rate of scapular spine fractures in IA patients, with a 24% prevalence observed in a RA cohort. 14 Furthermore, a recent systematic review highlighted that postoperative RSA clinical outcomes were inferior in IA patients when compared with the general population. Altogether, these results highlight that RSA for rotator cuff tears in IA patients likely results in similar functional outcomes in comparison to rotator cuff repair but may bring with it the risk of more significant postoperative complications.…”

Low acromial insufficiency fracture rate in reverse shoulder arthroplasty with distal clavicle excision

“…Preoperative and postoperative radiographic measurements of acromiohumeral interval (AHI), deltoid length, and position of the glenosphere center of rotation (COR) with respect to the lateral acromion were performed, using methodology from prior studies (Figure 1). 5,14 AHI was measured as the distance between the acromion and the most superior portion of the humerus. Deltoid length was measured as the distance from the acromion to the center of the deltoid tuberosity.…”