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Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

A CORR Insights to this article was published on 09 October 2014

Abstract

Background

Shoulder arthroplasty provides reliable pain relief and restoration of function. However, the effects of fatty infiltration and atrophy in the supraspinatus and infraspinatus muscles on functional outcomes are not well understood.

Questions/purposes

The purposes of this study were to (1) compare preoperative with postoperative fatty infiltration and atrophy of the supraspinatus and infraspinatus muscles after primary shoulder arthroplasty; and (2) identify any associations between these variables and outcome measures.

Methods

A retrospective analysis was undertaken of 62 patients with a mean age of 67 years (range, 34–90 years) who underwent shoulder arthroplasty. CT scans were conducted preoperatively and at 12 months postoperatively. Outcome variables included the degree of supraspinatus and infraspinatus fatty infiltration (percent fatty infiltration and Goutallier grade), muscle area (percent muscle area and Warner atrophy grade), shoulder strength, and the Western Ontario Osteoarthritis Score (WOOS), American Shoulder and Elbow Surgeons score, and Constant outcome score.

Results

Preoperatively, the mean percent fatty infiltration (FI) within the supraspinatus and infraspinatus was identical at 14%. One year after shoulder arthroplasty, both muscles had less fatty infiltration (6% and 7%, respectively; p < 0.001). Similarly, the Goutallier grade significantly improved postoperatively for the supraspinatus (p = 0.0037) and infraspinatus (p = 0.0007). Conversely, measures of muscle atrophy remained unchanged postoperatively (p > 0.251). Preoperatively, greater supraspinatus percent FI was negatively associated with preoperative shoulder strength (r = 0.37, p = 0.001) and Constant score (r = 0.38, p = 0.001). Postoperative infraspinatus percent FI was negatively associated with postoperative strength (r = 0.3, p = 0.021) and Constant score (r = 0.3, p = 0.04). Multivariable regression analysis of possible predictive factors demonstrated that preoperative supraspinatus percent muscle area (p = 0.016) and the diagnosis of osteoarthritis (p = 0.017) were associated with better followup WOOS scores, and preoperative supraspinatus strength was associated with postoperative strength (p = 0.0024). Higher degrees of preoperative percent FI were not associated with worse patient-reported outcomes postoperatively.

Conclusions

Supraspinatus and infraspinatus fatty infiltration improves after shoulder arthroplasty, whereas muscle area remains unchanged. Although further study of these variables is required, the negative associations identified between preoperative supraspinatus atrophy and the diagnosis of rheumatoid arthritis and postoperative quality-of-life outcome scores may aid the clinician in selecting the best treatment option for glenohumeral arthrosis and in the management of patient expectations.

Level of Evidence

Level III, prognostic study.

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Acknowledgments

We thank Ms Kimberly Paquin for her contributions in collection of patient outcome measures and data management.

Author information

Authors and Affiliations

  1. Division of Orthopedics, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, W1648, Box 502, Ottawa, ON, K1H 8L6, Canada

    Peter L. C. Lapner MD

  2. Department of Orthopedic Surgery, Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China

    Liangfu Jiang MD

  3. Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada

    Tinghua Zhang MSc

  4. St Joseph’s Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada

    George S. Athwal MD

Authors
  1. Peter L. C. Lapner MD
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  2. Liangfu Jiang MD
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  3. Tinghua Zhang MSc
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  4. George S. Athwal MD
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Corresponding author

Correspondence to Peter L. C. Lapner MD.

Additional information

One of the authors (GSA) received research funding support from Tornier Orthopedics Inc, Mississauga, Ontario, Canada.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Division of Orthopedics, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; and St Joseph’s Health Care, Hand and Upper Limb Centre, University of Western Ontario, London, Ontario, Canada.

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Lapner, P.L.C., Jiang, L., Zhang, T. et al. Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty. Clin Orthop Relat Res 473, 674–682 (2015). https://doi.org/10.1007/s11999-014-3963-5

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  • DOI: https://doi.org/10.1007/s11999-014-3963-5

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