Lesser Tuberosity Osteotomy Healing in Stemmed and Stemless Anatomic Shoulder Arthroplasty Is Higher with a Tensionable Construct and Affected by Body Mass Index and Tobacco Use

Cameron Phillips; Ignacio Pasqualini; Hugo Barros; Mariano E Menendez; Jeffrey L Horinek; Javier Ardebol; Patrick J Denard

doi:10.3390/jcm12030834

Lesser Tuberosity Osteotomy Healing in Stemmed and Stemless Anatomic Shoulder Arthroplasty Is Higher with a Tensionable Construct and Affected by Body Mass Index and Tobacco Use

J Clin Med. 2023 Jan 20;12(3):834. doi: 10.3390/jcm12030834.

Authors

Cameron Phillips¹, Ignacio Pasqualini¹, Hugo Barros², Mariano E Menendez¹, Jeffrey L Horinek¹, Javier Ardebol¹, Patrick J Denard¹

Affiliations

¹ Oregon Shoulder Institute, Medford, OR 97504, USA.
² Instituto de Hombro, Av. Rodrigo de Chávez Oe2-115, Quito 170104, Ecuador.

Abstract

Background: This study compared the healing rates of lesser tuberosity osteotomy (LTO) for anatomic total shoulder arthroplasty (TSA), repaired with either standard knot tying or a tensionable construct. Second, we evaluated LTO healing in stemmed and stemless prostheses and identified the patient characteristics associated with healing.

Methods: An analysis of consecutive primary TSAs approached with an LTO performed by a single surgeon between 2016 and 2020 was conducted. In the first two years of the study period, the LTOs were repaired with four #2 polyblend sutures passed through drill tunnels and around a short press-fit stem, followed by manual knot tying. Subsequently, a tensionable construct with suture tapes (TCB) was universally adopted. The radiographic appearance of the LTO was evaluated at a minimum of six months postoperatively.

Results: A total of 340 patients met the study criteria, including 168 with manual knot tying, 84 TCB repairs with a stemmed implant, and 88 TCB repairs with a stemless implant. There was no difference in the baseline demographics between the groups. The LTO healing rate of the manual knot tying group (85%) was lower than that of the stemmed (95%) and stemless (98%) TCB groups (p < 0.001). When directly comparing the LTO healing between the stemmed and stemless TCB groups, the differences were not significant (p = 0.44). Across all constructs, the body mass index (BMI) was higher in the displaced nonunion group (p = 0.04), with a failure rate of 9.4% for a BMI between 30 and 40, 12.5% for a BMI between 40 and 50, and 28.6% for a BMI > 50. The rate of tobacco use was higher in the displaced nonunion group (p = 0.037).

Conclusion: A tensionable construct improves LTO healing compared to manual knot tying, irrespective of the implant type. In addition to the surgical technique, the patient factors that influence tuberosity healing include a greater BMI and tobacco use.

Level of evidence: Level III, retrospective comparative study.

Keywords: lesser tuberosity osteotomy; short stem; stemless; subscapularis healing; tensionable repair; total shoulder arthroplasty.

Grants and funding

This research received no external funding.