Imaging characteristics of lesser tuberosity osteotomy after total shoulder replacement: a study of 220 patients

The lesser tuberosity osteotomy (LTO) has been gaining popularity as a method of exposing the glenohumeral joint during total shoulder replacement, whereby a small fragment of bone is removed from the lesser tuberosity, thus preserving the subscapularis tendon. To date, no large, randomized studies have reported evaluations of LTO healing and healing rates.

We reviewed the radiographs and available computed tomography images of 362 patients who underwent a total shoulder arthroplasty by the same surgeon between 2006 and 2012. The integrity of the LTO site was graded as not seen, bony union, nondisplaced nonunion, and displaced nonunion. The smoking status of patients was also assessed.

Of 362 patients investigated, 220 had a minimum of 6 months of radiographic follow-up. The LTO site was not seen in 37 patients; of the remaining 183, 159 patients (86.89%) demonstrated bony union, 8.80% of whom were smokers; 16 patients (8.74%) demonstrated nondisplaced nonunion, 6.3% of whom were smokers; and 8 patients (4.3%) demonstrated displaced nonunion, 25.0% of whom were smokers. Overall, 19 of the 24 nonunions were in male patients (79.1%) and 5 were in female patients (20.8%).

This is the first large-scale study to report the healing rate of LTOs. LTO healing is best assessed on radiographs; if nondisplaced or displaced nonunions are suspected, computed tomography can be a helpful additional examination. The number of radiographs where there is a lack of adequate visualization of the LTO site raises important questions about definitive radiographic evaluation using current techniques.