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. 2021 Jul 7:12:21514593211019973.
doi: 10.1177/21514593211019973. eCollection 2021.

Supraspinatus Tenotomy in Reverse Shoulder Arthroplasty for Fractures: A Comparative Cohort Study

Georg Siebenbürger  1 , Evi Fleischhacker  1 , Johannes Gleich  1 , Tobias Helfen  1 , Wolfgang Böcker  1 , Ben Ockert  1
Affiliations

Supraspinatus Tenotomy in Reverse Shoulder Arthroplasty for Fractures: A Comparative Cohort Study

Georg Siebenbürger et al. Geriatr Orthop Surg Rehabil. .

Abstract

Background: The aim of this study was to evaluate the functional and radiographic outcome in patients with reverse total shoulder arthroplasty (RSA) for displaced proximal humeral fractures (PHF) with or without tenotomy of the supraspinatus tendon.

Methods: Between June 2011 and June 2018, 159 patients (age >65 years) with a displaced proximal humeral fracture underwent reverse total shoulder arthroplasty (Grammont design) in a single-center study and were longitudinally followed up. In all cases, the tuberosities were attached to the prosthesis in a standardized procedure. Functional outcome, range of motion as well as tuberosity integration, resorption and displacement were assessed at final follow-up. Outcomes were compared between patients that underwent RSA in combination with tenotomy of the supraspinatus (ST) and patients that underwent RSA without supraspinatus tenotomy (NT).

Results: At a mean follow up of 22.2 ± 16.4 months 76 patients (mean age 77.1 ± 7.2 years, 83% women) could be evaluated (follow-up rate 47.8%). There were no statistically significant differences between the ST (n = 29) and NT groups (n = 47) in tuberosity integration, resorption </≥50%, or displacement (p = 0.99/0.31/0.7/0.99). Functional outcome was better in ST group (Constant score 76.2 ± 5.9 vs. 64.5 ± 12.8; p < 0.05) especially regarding mean active external rotation (>20°: 65.5% vs. 14.9%, p < 0.05) and active abduction (>120°: 89.7% vs. 21.3%, p < 0.05). Tuberosity integration (ST and NT together: n = 34) showed better functional results than resorption or displacement (p < 0.05).

Conclusions: Tenotomy of the supraspinatus tendon in RSA for displaced PHF leads to similar radiographic results regarding tuberosity integration, resorption and displacement but better functional outcome with regard to range of motion.

Level of evidence: III.

Keywords: RSA; arthroplasty; fracture; hemiarthroplasty; humerus; proximal humeral fracture; reverse total shoulder arthroplasty; rotator cuff; shoulder; supraspinatus tendon; tenotomy.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: None of the authors or any member of their family received any financial remuneration. The authors, their immediate family, and any foundation with which they are affiliated have not received any source of support (grants, equipment, other items), financial payments, or other benefits. The authors declare no conflicts of interest. There was no funding received for this work.

Figures

Figure 1.
Figure 1.
Postoperative plain radiographs in a.p. and axial radiographic view on the left side and secondary displacement of the greater tuberosity in RSA in a.p. and axial radiographic view on the right side.
Figure 2.
Figure 2.
Clinical outcome box plot CS (p < 0.05).
Figure 3.
Figure 3.
Clinical outcome box plot nCS (p < 0.05).
Figure 4.
Figure 4.
Complete integration of the tuberosities in RSA in a.p. and y-view radiographic view.
See this image and copyright information in PMC

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