William R Aibinder1, Ryan T Bicknell2, Stefan Bartsch3, Markus Scheibel4, George S Athwal5. 1. St. Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada. 2. Department of Surgery, Human Mobility Research Centre, Queen's University, Kingston, ON, Canada; Department of Mechanical and Materials Engineering, Human Mobility Research Centre, Queen's University, Kingston, ON, Canada. 3. Schaumburg Centre of Joint Surgery, Praxis am Wall Rinteln, Rinteln, Germany. 4. Department of Shoulder and Elbow Surgery, Schulthess Clinic Zürich, Zürich, Switzerland; Department of Shoulder and Elbow Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany. 5. St. Joseph's Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada. Electronic address: gathwal@uwo.ca.
Abstract
BACKGROUND: It is unknown whether subscapularis management technique has an influence on the outcomes and complications of stemless total shoulder arthroplasty. The purpose of this study, therefore, was to compare outcomes and complications between subscapularis tenotomy, peel, and lesser tuberosity osteotomy used during stemless shoulder arthroplasty. METHODS: We reviewed 188 stemless anatomic total shoulder arthroplasties and compared clinical and functional outcomes between those performed through a subscapularis tenotomy (n = 68), subscapularis peel (n = 65), or lesser tuberosity osteotomy (n = 55). Patients were followed up clinically and radiographically at 6 months, 1 year, and 2 years postoperatively. RESULTS: At 2 years postoperatively, no statistically significant differences in visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, or patient-reported instability (P ≥ .19) were found between groups. Active external rotation was greater in the peel group (P = .006) than in the tenotomy group but was not different compared with the lesser tuberosity osteotomy group (P = .07). No statistically significant difference in clinical subscapularis failures was noted between groups (P = .11); however, 2 patients in the peel group sustained a subscapularis failure requiring reoperation. DISCUSSION: The results of this multicenter comparative analysis show that all 3 subscapularis management techniques are effective and safe in the short term when used with stemless anatomic total shoulder arthroplasty.
BACKGROUND: It is unknown whether subscapularis management technique has an influence on the outcomes and complications of stemless total shoulder arthroplasty. The purpose of this study, therefore, was to compare outcomes and complications between subscapularis tenotomy, peel, and lesser tuberosity osteotomy used during stemless shoulder arthroplasty. METHODS: We reviewed 188 stemless anatomic total shoulder arthroplasties and compared clinical and functional outcomes between those performed through a subscapularis tenotomy (n = 68), subscapularis peel (n = 65), or lesser tuberosity osteotomy (n = 55). Patients were followed up clinically and radiographically at 6 months, 1 year, and 2 years postoperatively. RESULTS: At 2 years postoperatively, no statistically significant differences in visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, or patient-reported instability (P ≥ .19) were found between groups. Active external rotation was greater in the peel group (P = .006) than in the tenotomy group but was not different compared with the lesser tuberosity osteotomy group (P = .07). No statistically significant difference in clinical subscapularis failures was noted between groups (P = .11); however, 2 patients in the peel group sustained a subscapularis failure requiring reoperation. DISCUSSION: The results of this multicenter comparative analysis show that all 3 subscapularis management techniques are effective and safe in the short term when used with stemless anatomic total shoulder arthroplasty.
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