Lesser tuberosity osteotomy for total shoulder arthroplasty. Surgical technique

Area of Science:

• Orthopedic Surgery
• Shoulder Arthroplasty
• Musculoskeletal Research

Background:

• Subscapularis tendon repair failure after anterior shoulder approaches is a concern.
• Alternative methods aim to improve subscapularis function and healing after total shoulder replacement.

Purpose of the Study:

• To evaluate the clinical and structural outcomes of lesser tuberosity osteotomy for anterior shoulder replacement.
• To assess bone healing and subscapularis function following this surgical technique.

Main Methods:

• Retrospective review of 39 shoulders (36 patients) undergoing total shoulder replacement with lesser tuberosity osteotomy.
• Assessment included clinical scoring (Constant and Murley), physical examination (belly-press, lift-off tests), and imaging (radiography, CT) at an average of 39 months post-op.

Main Results:

• Consistent anatomical bone-to-bone healing of the osteotomy site was observed in all shoulders.
• High rates of normal subscapularis function were reported (89% negative belly-press, 75% normal lift-off).
• Significant increase in subscapularis fatty infiltration (≥ stage 2 in 32%) was noted postoperatively, despite anatomical healing.

Conclusions:

• Lesser tuberosity osteotomy is an effective anterior approach for total shoulder replacement, facilitating bone healing and good subscapularis function.
• Postoperative subscapularis fatty infiltration, even with anatomical osteotomy healing, is unexplained and linked to poorer outcomes.
• Further research is needed to understand the mechanisms behind postoperative fatty infiltration.