Shoulder arthroplasty using mini-stem humeral components and a lesser tuberosity osteotomy

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Musculoskeletal Research

Background:

• The combination of lesser tuberosity osteotomy (LTO) and mini-stem humeral components (MSHCs) in shoulder arthroplasty is a developing surgical technique.
• Evaluating the safety and efficacy of this combined approach is crucial for optimizing patient outcomes in total and hemi-shoulder arthroplasty (TSA/HHA).

Purpose of the Study:

• To determine the safety and effectiveness of utilizing lesser tuberosity osteotomy (LTO) in conjunction with mini-stem humeral components (MSHCs) for total and hemi-shoulder arthroplasty (TSA/HHA).
• To assess the union rates of LTO and the stability of MSHCs in TSA/HHA patients.

Main Methods:

• A retrospective review was conducted on consecutive patients undergoing anatomic TSA/HHA with combined LTO/MSHC.
• Minimum follow-up of 2 years was required, with assessment of six-week and final radiographs, range of motion, pain scores, and functional outcome measures.

Main Results:

• Out of 75 shoulders analyzed, 89.3% demonstrated uneventful LTO healing, with a 6.67% failure rate.
• Significant improvements were observed in ASES, SANE, VAS scores, and range of motion (forward flexion, external rotation, internal rotation) (p < 0.001).
• Component loosening was uncommon, with only 5.33% of stems subsiding, and one requiring revision.

Conclusions:

• The combined use of LTO and MSHCs is appropriate for TSA/HHA, leading to pain relief and functional gains.
• Component loosening appears infrequent in early follow-up, and LTO/MSHC use is a safe and effective surgical strategy when performed correctly.
• Availability of long-stem components is recommended for cases with compromised metaphyseal bone integrity.