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Updated: Apr 11, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Low glenoid neck Hounsfield units predict patients at high risk of mechanical complication after total shoulder
Patrick Sun1, Cathleen Cahill2, Darlington Nwaudo2
1Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Background:
Computed tomography Hounsfield units (HUs) estimate bone mineral density, but their predictive value for total shoulder arthroplasty (TSA) mechanical complications is unknown. This study assessed whether glenoid HU (gHU) can be used to predict mechanical complication risk.
Methods:
In this retrospective cohort study at a single tertiary academic center (January 2011-April 2024), pre-operative computed tomography scans from 250 TSAs in 233 patients were independently reviewed by 3 interdisciplinary reviewers to measure gHU. Mechanical complications, including periprosthetic or intraoperative fractures and aseptic implant loosening, were identified and stratified by gHU. Inter-rater reliability was assessed with the intraclass correlation coefficient. Receiver operating characteristic analysis identified optimal gHU thresholds. Risk-group comparisons used chi-square tests and multivariable logistic regression.
Results:
Among 250 TSAs in 233 patients, intraclass correlation coefficient for gHU measurement was 0.90 (95% confidence interval 0.87-0.92). Receiver operating characteristic analysis yielded a cutoff of 177 HU (area under the curve 0.59; sensitivity 39%; specificity 81%). Mechanical complications occurred in 29% of cases with gHU <177 vs. 13% with gHU ≥177 (P = .008; adjusted P = .02). Patients with gHU <110 had the highest risk (57% vs. 14%; P < .001; adjusted P = .002).
Conclusion:
Pre-operative gHU measurements can help to predict increased risk of mechanical complications after TSA. A gHU threshold of 177 HU identifies patients at elevated risk, while gHU <110 marks the highest-risk group.
