Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study

Background: Stemless total shoulder arthroplasty (TSA) continues to grow in popularity as an evolution of stemmed humeral implants. Proposed advantages include bone preservation and ease of potential revision. However, absence of a stem may necessitate a change in subscapularis takedown approach. Sp...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Chinedu Okafor, BA, MS, Albert T. Anastasio, MD, Robert A. Christian, MD, MBA, Christopher S. Klifto, MD, Tally Lassiter, MD, MHA, Oke Anakwenze, MD, MBA
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Subscapular TSA Stemless Shoulder replacement Osteoarthritis Glenohumeral arthritis Surgery RD1-811
Acceso en línea:	https://doaj.org/article/e9769417311445e78537267e6ddb038e
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e9769417311445e78537267e6ddb038e
record_format	dspace
spelling	oai:doaj.org-article:e9769417311445e78537267e6ddb038e2021-11-22T04:32:07ZSubscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study2666-639110.1016/j.xrrt.2021.07.003https://doaj.org/article/e9769417311445e78537267e6ddb038e2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666639121000699https://doaj.org/toc/2666-6391Background: Stemless total shoulder arthroplasty (TSA) continues to grow in popularity as an evolution of stemmed humeral implants. Proposed advantages include bone preservation and ease of potential revision. However, absence of a stem may necessitate a change in subscapularis takedown approach. Specifically, there is theoretical concern about violation of supportive bone with lesser tuberosity osteotomy when using a stemless device. Therefore, the goal of this study was to identify if surgeons change their subscapularis takedown preference when performing stemless vs. stemmed TSA. Methods and materials: Data from a consecutive series of patients who underwent stemmed and stemless TSA at an academic institution were collected. The subscapularis management technique was documented. Subscapularis takedown techniques were divided into 2 groups: soft-tissue approach (subscapularis tenotomy or peel) and bony approach (lesser tuberosity osteotomy). Historical preference for each surgeon was determined by evaluating techniques employed using stemmed TSA. A Cramers V analysis was run to determine the strength of association between this historical preference and subscapularis management technique used for stemless TSA. Results: One hundred and fifty-four patients were included in this analysis. There were 72 and 82 stemmed and stemless arthroplasty cases performed, respectively. Of the 154 patients, 50.6% were women. The average age of patients was 64.2 years. Four surgeons were included in this study. In all, there were 79 and 75 bony and soft-tissue subscapularis techniques, respectively. The historical preference for 3 of the surgeons was a subscapularis bony approach, and the historical preference for one of the surgeons was a soft-tissue approach. A Cramer’s V analysis was used to measure the relative strength of association between patient factors, historical subscapularis management preference, and subscapularis takedown approach in stemless TSA. Our analysis yielded a value of 0.65 (P < .01), indicating a redundant association between subscapularis management approach used between stemmed and stemless implant per surgeon. Conclusion: In determining subscapularis tendon management strategy, in surgeons who performed stemmed TSA before stemless TSA, the subscapularis takedown approach used for stemless TSA is strongly associated with surgeon’s historical preference for stemmed TSA. Future research will be needed to determine the clinical ramifications of this finding.Chinedu Okafor, BA, MSAlbert T. Anastasio, MDRobert A. Christian, MD, MBAChristopher S. Klifto, MDTally Lassiter, MD, MHAOke Anakwenze, MD, MBAElsevierarticleSubscapularTSAStemlessShoulder replacementOsteoarthritisGlenohumeral arthritisSurgeryRD1-811ENJSES Reviews, Reports, and Techniques, Vol 1, Iss 4, Pp 353-356 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Subscapular TSA Stemless Shoulder replacement Osteoarthritis Glenohumeral arthritis Surgery RD1-811
spellingShingle	Subscapular TSA Stemless Shoulder replacement Osteoarthritis Glenohumeral arthritis Surgery RD1-811 Chinedu Okafor, BA, MS Albert T. Anastasio, MD Robert A. Christian, MD, MBA Christopher S. Klifto, MD Tally Lassiter, MD, MHA Oke Anakwenze, MD, MBA Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study
description	Background: Stemless total shoulder arthroplasty (TSA) continues to grow in popularity as an evolution of stemmed humeral implants. Proposed advantages include bone preservation and ease of potential revision. However, absence of a stem may necessitate a change in subscapularis takedown approach. Specifically, there is theoretical concern about violation of supportive bone with lesser tuberosity osteotomy when using a stemless device. Therefore, the goal of this study was to identify if surgeons change their subscapularis takedown preference when performing stemless vs. stemmed TSA. Methods and materials: Data from a consecutive series of patients who underwent stemmed and stemless TSA at an academic institution were collected. The subscapularis management technique was documented. Subscapularis takedown techniques were divided into 2 groups: soft-tissue approach (subscapularis tenotomy or peel) and bony approach (lesser tuberosity osteotomy). Historical preference for each surgeon was determined by evaluating techniques employed using stemmed TSA. A Cramers V analysis was run to determine the strength of association between this historical preference and subscapularis management technique used for stemless TSA. Results: One hundred and fifty-four patients were included in this analysis. There were 72 and 82 stemmed and stemless arthroplasty cases performed, respectively. Of the 154 patients, 50.6% were women. The average age of patients was 64.2 years. Four surgeons were included in this study. In all, there were 79 and 75 bony and soft-tissue subscapularis techniques, respectively. The historical preference for 3 of the surgeons was a subscapularis bony approach, and the historical preference for one of the surgeons was a soft-tissue approach. A Cramer’s V analysis was used to measure the relative strength of association between patient factors, historical subscapularis management preference, and subscapularis takedown approach in stemless TSA. Our analysis yielded a value of 0.65 (P < .01), indicating a redundant association between subscapularis management approach used between stemmed and stemless implant per surgeon. Conclusion: In determining subscapularis tendon management strategy, in surgeons who performed stemmed TSA before stemless TSA, the subscapularis takedown approach used for stemless TSA is strongly associated with surgeon’s historical preference for stemmed TSA. Future research will be needed to determine the clinical ramifications of this finding.
format	article
author	Chinedu Okafor, BA, MS Albert T. Anastasio, MD Robert A. Christian, MD, MBA Christopher S. Klifto, MD Tally Lassiter, MD, MHA Oke Anakwenze, MD, MBA
author_facet	Chinedu Okafor, BA, MS Albert T. Anastasio, MD Robert A. Christian, MD, MBA Christopher S. Klifto, MD Tally Lassiter, MD, MHA Oke Anakwenze, MD, MBA
author_sort	Chinedu Okafor, BA, MS
title	Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study
title_short	Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study
title_full	Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study
title_fullStr	Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study
title_full_unstemmed	Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study
title_sort	subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/e9769417311445e78537267e6ddb038e
work_keys_str_mv	AT chineduokaforbams subscapularismanagementinstemmedandstemlesstotalshoulderarthroplastyasurgeondecisionmakinganalysisstudy AT alberttanastasiomd subscapularismanagementinstemmedandstemlesstotalshoulderarthroplastyasurgeondecisionmakinganalysisstudy AT robertachristianmdmba subscapularismanagementinstemmedandstemlesstotalshoulderarthroplastyasurgeondecisionmakinganalysisstudy AT christopherskliftomd subscapularismanagementinstemmedandstemlesstotalshoulderarthroplastyasurgeondecisionmakinganalysisstudy AT tallylassitermdmha subscapularismanagementinstemmedandstemlesstotalshoulderarthroplastyasurgeondecisionmakinganalysisstudy AT okeanakwenzemdmba subscapularismanagementinstemmedandstemlesstotalshoulderarthroplastyasurgeondecisionmakinganalysisstudy
_version_	1718418195796197376

Subscapularis management in stemmed and stemless total shoulder arthroplasty: a surgeon decision-making analysis study

Ejemplares similares