Preop acromio pathology does not affect reverse shoulder arthroplasty results

Patients with a preoperative os acromiale had a 'slight' statistical advantage in Constant scores for function compared to those with acromion fracture or fragmentation.

SAN DIEGO — Preoperative acromio pathologies do not appear to significantly influence function following reverse shoulder arthroplasty, at least in the short term, according to a surgeon speaking here.

Bryan Wall

However, postoperative scapular spine fractures "should be recognized as a significant complication and, in such cases, [open reduction and internal fixation] may be warranted," said Bryan Wall, MD.

Wall and colleagues evaluated the pre- and postoperative incidence of acromio pathology in patients treated with reverse shoulder arthroplasty. They also analyzed the effect such acromio pathologies have on functional outcomes. Wall presented the study results at the American Academy of Orthopaedic Surgeons annual meeting.

The study included 457 reverse shoulder arthroplasties implanted by seven surgeons. Investigators prospectively collected all data. Patients averaged 72.3 years of age and were followed for a minimum of 2 years postop.

Surgeons performed reverse shoulder arthroplasty in 10 cases for massive rotator cuff tears, in 28 cases for cuff tear arthropathy and in three cases for revision of a failed hemiarthroplasty.

Of the 457 cases, the researchers identified 41 patients who had preoperative acromio pathology, yielding a 9% overall incidence. Of these 41 patients, 23 had an os acromiale and 17 presented with either a fracture or fragmentation of the acromion preoperatively. One patient had a preoperative stress fracture of the scapular spine, Wall noted.

Patients with a preoperative os acromiale had a "slight" statistical advantage in terms of Constant scores for function (P<.63). "This slight advantage held true for the individual portions of the Constant score with respect to activity as well as mobility," he said.

However, comparing patients in the final act of forward elevation, "We could show no statistically significant difference across groups," Wall said.

More than 90% of patients indicated that they were either satisfied or very satisfied with their surgical outcomes.

For more information:
Wall and his colleagues received financial support from Tornier.
Wall B, Mottier F, Walch G. The pathologic acromion in reverse shoulder arthroplasty. #33. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18. 2007. San Diego.