PMID- 36470370
OWN - NLM
STAT- MEDLINE
DCOM- 20230523
LR  - 20230523
IS  - 1877-0568 (Electronic)
IS  - 1877-0568 (Linking)
VI  - 109
IP  - 4
DP  - 2023 Jun
TI  - Influence of humeral lengthening on clinical outcomes in reverse shoulder 
      arthroplasty.
PG  - 103502
LID - S1877-0568(22)00361-9 [pii]
LID - 10.1016/j.otsr.2022.103502 [doi]
AB  - BACKGROUND: Deltoid tensioning secondary to humeral lengthening after reverse 
      shoulder arthroplasty (RSA) is commonly theorized to be crucial to improving 
      range of motion (ROM) but may predispose patients to acromial/scapular spine 
      fractures and neurologic injury. Clinical evidence linking patient outcomes to 
      humeral lengthening is limited. This study assesses the relationship between 
      humeral lengthening and clinical outcomes after RSA. METHODS: A single 
      institution review of 284 RSAs performed in 265 patients was performed. Humeral 
      lengthening was defined as the difference in the subacromial height 
      preoperatively to postoperatively as measured on Grashey radiographs. The 
      subacromial height was measured as the vertical difference between the most 
      inferolateral aspect of the acromion and the most superior aspect of the greater 
      tuberosity. The relationship between humeral lengthening and clinical outcomes 
      was assessed on a continuous basis. Secondarily, clinical outcomes were assessed 
      using a dichotomous definition of humeral lengthening (</=25 vs. >25mm) based on 
      prior clinical and biomechanical work purporting a correlation with clinical 
      outcomes. Improvement exceeding the minimal clinically important difference 
      (MCID) and substantial clinical benefit (SCB) for ROM and outcome scores after 
      RSA were also compared. RESULTS: Humeral lengthening demonstrated a nonlinear 
      relationship with postoperative ROM, clinical outcome scores, and shoulder 
      strength and their improvement preoperatively to postoperatively. Furthermore, 
      there were minimal differences in ROM measures, outcome scores, and shoulder 
      strength when stratified using the dichotomous definition of humeral lengthening. 
      No difference in the proportion of patients exceeding the MCID or SCB when 
      stratified by humeral lengthening </=25 vs. >25mm was found. There was no 
      difference in humeral lengthening in patients with versus without complications. 
      CONCLUSION: No clear relationship between humeral lengthening and clinical 
      outcomes was identified. The previously purported 25mm threshold for humeral 
      lengthening did not predict improved patient outcomes. Outcomes after RSA are 
      multifactorial; the relationship between humeral lengthening and outcomes is 
      likely confounded by other patient and surgical factors. LEVEL OF EVIDENCE: IV; 
      Case Series.
CI  - Copyright (c) 2022. Published by Elsevier Masson SAS.
FAU - Hao, Kevin A
AU  - Hao KA
AD  - College of Medicine, University of Florida, Gainesville, FL, USA.
FAU - Dean, Ethan W
AU  - Dean EW
AD  - Piedmont Orthopedics | OrthoAtlanta, Atlanta, GA, USA.
FAU - Hones, Keegan M
AU  - Hones KM
AD  - College of Medicine, University of Florida, Gainesville, FL, USA.
FAU - King, Joseph J
AU  - King JJ
AD  - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 
      Gainesville, FL, USA.
FAU - Schoch, Bradley S
AU  - Schoch BS
AD  - Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
FAU - Dean, Natalie E
AU  - Dean NE
AD  - Department of Biostatistics and Bioinformatics, Rollins School of Public Health, 
      Emory University, Atlanta, GA, USA.
FAU - Farmer, Kevin W
AU  - Farmer KW
AD  - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 
      Gainesville, FL, USA.
FAU - Struk, Aimee M
AU  - Struk AM
AD  - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 
      Gainesville, FL, USA.
FAU - Wright, Thomas W
AU  - Wright TW
AD  - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 
      Gainesville, FL, USA. Electronic address: wrightw@ortho.ufl.edu.
LA  - eng
PT  - Journal Article
DEP - 20221205
PL  - France
TA  - Orthop Traumatol Surg Res
JT  - Orthopaedics & traumatology, surgery & research : OTSR
JID - 101494830
SB  - IM
MH  - Humans
MH  - *Arthroplasty, Replacement, Shoulder/methods
MH  - *Shoulder Joint/diagnostic imaging/surgery
MH  - Treatment Outcome
MH  - Shoulder/surgery
MH  - Humerus/diagnostic imaging/surgery
MH  - Range of Motion, Articular
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Acromion
OT  - Arm
OT  - Distalization
OT  - Fracture
OT  - RTSA
OT  - Scapular spine
EDAT- 2022/12/06 06:00
MHDA- 2023/05/23 06:42
CRDT- 2022/12/05 19:24
PHST- 2022/07/04 00:00 [received]
PHST- 2022/08/28 00:00 [revised]
PHST- 2022/09/07 00:00 [accepted]
PHST- 2023/05/23 06:42 [medline]
PHST- 2022/12/06 06:00 [pubmed]
PHST- 2022/12/05 19:24 [entrez]
AID - S1877-0568(22)00361-9 [pii]
AID - 10.1016/j.otsr.2022.103502 [doi]
PST - ppublish
SO  - Orthop Traumatol Surg Res. 2023 Jun;109(4):103502. doi: 
      10.1016/j.otsr.2022.103502. Epub 2022 Dec 5.