Do preoperative scapular fractures affect long-term outcomes after reverse shoulder arthroplasty?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Radiology

Background:

• Postoperative scapular stress fractures (SSFs) are a known complication of reverse shoulder arthroplasty (RSA).
• Preoperative SSFs are less understood, particularly their impact on patient outcomes after RSA.
• This study investigates patient satisfaction and functional outcomes in primary RSA patients with preoperative SSFs compared to a matched cohort without fractures.

Purpose of the Study:

• To compare postoperative satisfaction in primary RSA patients with preoperative SSFs versus a matched cohort without fractures.
• To analyze differences in patient-reported outcomes (ASES and VAS scores) between these groups.
• To evaluate functional outcomes based on SSF classification (Os acromiale, multifragment, Levy types).

Main Methods:

• Retrospective review of primary RSAs performed between 2000-2020.
• Inclusion criteria: cuff tear arthropathy (CTA), massive cuff tear (MCT), or rheumatoid arthritis (RA).
• Patients with SSFs on preoperative CT scans were categorized into Os acromiale, multifragment (MF), or Levy types; compared to a nonfractured cohort. ASES and VAS scores were assessed pre- and postoperatively.

Main Results:

• The overall incidence of SSF was 13.7%.
• Patients with preoperative SSFs reported significantly lower satisfaction scores (5.4 vs. 7.9, P < .001) and ASES total scores (62.1 vs. 69.4, P = .02) at the final visit compared to the nonfractured group.
• The MF subgroup demonstrated worse functional ASES and VAS scores at all postoperative time points compared to the Os/Levy subgroup.

Conclusions:

• Preoperative SSFs in primary RSA patients are associated with reduced postoperative satisfaction and functional outcomes compared to nonfractured patients.
• Multifragment scapular fractures lead to significantly poorer functional outcomes post-RSA.
• While ASES scores improve post-RSA in patients with SSFs, satisfaction remains lower than in their nonfractured counterparts.