Effect of humeral lengthening on post-operative pain scores by three-dimensional measurements in patients undergoing reverse shoulder arthroplasty.

Abstract

Purpose: Humeral lengthening (HL) has been reported to correlate with post-operative clinical outcomes of reverse shoulder arthroplasty (RSA). However, these are simple radiographic evaluations, and three-dimensional (3D) assessments using computed tomography (CT) images have not been considered. This study aimed to investigate the factors that influence post-operative clinical outcomes of RSA implant placement using a 3D evaluation system, specifically, the effect of HL on post-operative clinical outcomes.

Methods: This retrospective study included 49 patients who underwent RSA using the Exactech Equinoxe Reverse Shoulder System (Exactech Inc., Gainesville, FL, USA) for cuff tear arthropathy or irreparable rotator cuff tear between August 2017 and June 2021 and were followed up for at least two years post-operatively. An augmented baseplate was used in 19 patients. Pre- and post-operative CT images were used to evaluate post-operative implant placement using the 3D planning software ZedShoulder software (Lexi, Tokyo, Japan). Global offset, overhang of glenosphere, glenoid version, glenoid inclination, HL, and amount of humeral resection were measured. Clinical outcomes were also evaluated in relation to post-operative implant placement.

Results: Univariate analysis revealed that HL correlated with the pain score of Constant-Murley score and visual analog scale (VAS) (r=-0.37, p = 0.01; r = 0.38, p = 0.01). Moreover, the overhang of the glenosphere correlated with the Constant-Murley score and the pain score of the Constant-Murley score (r=-0.34, p = 0.02; r = 0.31, p = 0.03). Using multivariate analysis, HL and the overhang of the glenosphere were factors influencing the pain score on the Constant-Murley score (R² = 0.502). Allocating patients with HL into two groups based on the amount of lengthening (≤ 18 mm and > 18 mm), the pain score of the Constant-Murley score and pain VAS were significantly lower in the group with HL of ≤ 18 mm (p < 0.01, p < 0.01).

Conclusion: HL affected post-operative pain scores in patients undergoing RSA. Particularly, the group with HL of ≤ 18 mm had a significantly lower pain score. Therefore, we suggest that post-operative pain scores could be improved by reducing the HL to ≤ 18 mm. However, this was a retrospective study with a small number of cases, and the correlation between HL and outcomes requires further investigation.