The effect of humeral stem alignment in reverse shoulder arthroplasty |
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| Institution: | 1. Massachusetts General Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA;2. New England Baptist Hospital, Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA;3. Tufts Medical Center, Department of Orthopaedic Surgery, Tufts University School of Medicine Boston, MA, USA;1. Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA;2. Department of Orthopaedics and Traumatology, Villa del Sole Clinic, Catanzaro, Italy;1. Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA;2. Foundation for Orthopaedic Research and Education, Translational Research, Tampa, FL, USA;3. University of South Florida, Department of Medical Engineering, College of Engineering & Morsani College of Medicine, Tampa, FL, USA;4. University of South Florida, Tampa, FL, USA |
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| Abstract: | BackgroundThe impact of stem alignment on hip arthroplasty outcomes has been thoroughly evaluated, but there is limited data assessing this relationship in reverse shoulder arthroplasty (RSA). In this study, we investigated the association of humeral stem alignment with patient outcomes following RSA.MethodsUsing our prospectively maintained institutional registry, we identified patients who underwent reverse shoulder arthroplasty between July 2015 and September 2017 with minimum 2-year follow-up. Two raters independently assessed stem alignment using full-length humeral view radiographs. Stem alignment was correlated to American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS) pain score, range of motion, complications, and scapular notching at 2-year follow-up.ResultsOf the 117 patients that fit our inclusion criteria, 68 (58%) had neutral or valgus alignment and 49 (42%) had varus alignment. ASES score, VAS pain score, range of motion, complications, and scapular notching showed no differences between the 2 cohorts at 2-years postoperatively. Change (mean, SD) in ASES scores (52.5 ± 17.7 vs. 41.3 ± 21.2, P = .01) and VAS pain scores (?5.7 ± 2.5 vs. ?4.6 ± 2.6, P = .02) were greater in the neutral/valgus cohort compared to the varus cohort. Demographics analysis revealed that the neutral or valgus cohort had a larger female population (74% vs. 59%, P < .01) while men were more likely to be in the varus cohort.ConclusionHumeral stem alignment does not appear to affect clinical outcomes at 2-years postoperatively. Improvement in ASES score and VAS pain score were slightly inferior in varus patients, however this difference was not clinically relevant. There may be a correlation between male gender and varus alignment, likely due to better bone quality and larger musculature. Further investigation into the association between stem angulation and clinical outcomes is warranted.Levels of EvidenceLevel III; Retrospective Cohort Study. |
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