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Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty: a multicentric retrospective study

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Abstract

Purpose

Scapular stress fracture (sSF) is a difficult complication to treat after reverse total shoulder arthroplasty (RSA). The aim of this study was to identify the prevalence and possible risk factors in a large population.

Methods

A total of 2165 RSAs that were implanted between January 2006 and October 2017 in five hospitals were evaluated. Within this cohort, sSF was radiologically confirmed. Age, gender, surgical indication and hospital of treatment were determined for the entire cohort. A matched 3:1 case-control study was then performed to investigate several clinical and surgical variables.

Results

sSF occurred in 3.1% (63 patients), with a median time interval of five months post-operative [IQR = 9, range: (1–79)]. Within the entire cohort, females (OR = 2.99) and rotator cuff arthropathy (RCA) (OR = 2.79) were more prone to this complication. Age had little influence (OR = 1.03). After exclusion, fifty-five eligible cases were matched to 165 controls based on hospital, gender, age and surgical indication. After univariable analysis, significance was obtained for osteopenia (P = 0.037), osteoporosis (P = 0.032), surgical approach (P = 0.002) and peri-operative acromioclavicular (AC) joint surgery (P = 0.035). Multivariate analysis demonstrated that osteopenia (OR = 3.94), osteoporosis (OR = 2.85) and a deltopectoral approach (OR = 3.70) were independent risk factors.

Conclusion

According to our findings, older women with poor bone quality and a history of RCA suffered more frequently from sSF. Anterolateral approach during surgery was a surgical protective factor, possibly due to the mobilization of the acromioclavicular joint. Although this study indicates who is at risk for sSF, further investigation for prevention of sSF in these patients is necessary.

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Data availability

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium

    O. Verstraete & B. Van der Mast

  2. Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000, Ghent, Belgium

    A. Van Tongel, A. Karelse & L. De Wilde

  3. Department of Orthopaedic Surgery and Traumatology, General Hospital Sint-Lucas Ghent, Ghent, Belgium

    H. Van der Bracht & P. Verniers

  4. Department of Orthopaedic Surgery and Traumatology, General Hospital Bruges, Bruges, Belgium

    B. Berghs & T. Van Isacker

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  1. O. Verstraete
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  2. B. Van der Mast
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  4. A. Karelse
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  5. H. Van der Bracht
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Correspondence to O. Verstraete.

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Level of evidence: Level 3; therapeutic retrospective case control study

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Verstraete, O., Van der Mast, B., Van Tongel, A. et al. Prevalence and risk factors of scapular stress fracture after reverse shoulder arthroplasty: a multicentric retrospective study. International Orthopaedics (SICOT) 45, 209–216 (2021). https://doi.org/10.1007/s00264-020-04849-7

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  • DOI: https://doi.org/10.1007/s00264-020-04849-7

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