Treatment Outcomes of Lesser Tuberosity Osteotomy Nonunion After Total Shoulder Arthroplasty. (November 2018)

• Record Type: Journal Article
• Authors: Bloom, Zachary J; Lopez, BA, Cesar D; Maier, Stephen P; Shiu, Brian B; Petkovic, Djuro; Levine, William N; Jobin, Charles M
• Is Part Of: Journal of shoulder and elbow arthroplasty. Volume 2(2018)
• Publication Date: 2018-11
• Subjects: Arthroplasty -- lesser tuberosity osteotomy -- nonunion -- orthopedic surgery -- shoulder -- subscapularis; Arthroplasty -- Periodicals; Shoulder joint -- Surgery -- Periodicals; Elbow -- Surgery -- Periodicals; 617.57
• DOI: 10.1177/2471549218807777
• Languages: English
• ISSNs: 2471-5492

Abstract

Introduction: Lesser tuberosity osteotomy (LTO) during anatomic total shoulder arthroplasty has a 13% nonunion rate. Treatment for LTO nonunion is controversial and poorly described in the literature. The purpose of this study was to compare the surgical and nonsurgical treatment outcomes of LTO nonunion. Methods: A retrospective case series of 9 consecutive patients with LTO nonunion after primary anatomic shoulder arthroplasty at 1 institution from 2010 to 2016 were studied. Outcomes measured were radiographic evaluation of LTO on axillary X-ray, clinical range of motion (ROM), subscapularis strength, and pain at the time of LTO nonunion diagnosis and after either conservative care or surgical repair of the LTO nonunion. Results: LTO nonunion was treated surgically in 4 and conservatively in 5 patients with average follow-up of 30 and 22 months, respectively. There were no significant differences in age, sex, or smoking status between groups. Treatment decision was a shared model of surgeon and patient. Displaced LTO nonunion was treated surgically in 2 and conservatively in 3 patients. There were no differences in LTO union rate of 50% in the surgical versus 60% in the conservative group. Abdominal compression test was abnormal in 50% of surgical versus 40% of conservative groups. At follow-up, ROM was lower in the surgical group with 128° forward elevation (FE) and 33° external rotation (ER) compared to 148° FE and 62° ER. Only 1 patient with LTO nonunion required conversion to reverse replacement. Conclusion: LTO nonunion after shoulder arthroplasty is rare. Surgical repair of LTO nonunion does not significantly improve clinical or radiographic outcomes compared to conservative care.