Two-Year Functional and Radiographic Outcomes Following Large Lesser Tuberosity Osteotomy in Stemless Anatomic Total Shoulder Arthroplasty: A Case Series.

Abstract

Despite debate over the optimal surgical management of the subscapularis in anatomic total shoulder arthroplasty (aTSA), no prior studies have reported 2-year functional and radiographic outcomes in patients undergoing stemless aTSA with a large lesser tuberosity osteotomy. Retrospective review of all patients who underwent stemless aTSA with a large lesser tuberosity osteotomy at a single institution with minimum 2-year follow-up was done. Patient demographics and outcomes were recorded, including active range of motion standardized subscapularis strength testing, and complication rates. Outcomes included the visual analog scale (VAS) pain score and the American Shoulder and Elbow Surgeons (ASES) score. Radiographic outcomes included evidence of lesser tuberosity osteotomy healing and implant loosening. Overall, 54 patients were included, 44 (83.0%) of which with minimum 2-year follow-up. At 2 years postoperatively, active forward elevation, external rotation, VAS pain, and ASES scores markedly improved compared with preoperatively (P < 0.001). Internal rotation strength testing was comparable to the contralateral limb (13.8 vs. 15.2 lbs, P = 0.38). Complete radiographic lesser tuberosity osteotomy healing was identified in 38 of 41 patients (93%), and none had a displaced osteotomy. Eighty-one percent (33 of 41) of patients had a Churchill grade of 0 of the humeral components. Revision surgeries occurred only for cerclage wire removal (13.6%, n = 6). The average ASES and VAS pain scores after cerclage wire removal were 85 (range 63-100, SD, 14.0) and 1.0 (range 0-4, SD 1.7), respectively. Patients undergoing stemless aTSA with a large lesser tuberosity osteotomy repaired with cerclage wires demonstrate excellent functional and radiographic outcomes, with a 93% complete healing rate, no cases of osteotomy displacement, and internal rotation strength equal to the contralateral limb. Despite 13% of patients requiring subsequent wire removal, outcomes were comparable to patients not requiring removal. IV.