The largest published study1 of its kind demonstrates the Equinoxe reverse acromial and scapular fracture rate is 1.52%1-2, which is >2x3-7 lower than the other prosthesis designs2, whether inlay or onlay, referenced in the study.
Not All Reverses Are Created Equal
Equinoxe®: >2x reduction in acromial and scapular fracture rate
0%
Equinoxe1,2
3.1-10.2%
Lateral Glenoid Inlay4-6
4.3%
Curved Stem Onlay7
The largest published study1 of its kind demonstrates the Equinoxe reverse acromial and scapular fracture rate is 1.52%1-2, which is >2x3-7 lower than the other prosthesis designs2, whether inlay or onlay, referenced in the study.
0%
Equinoxe1,2
3.1-10.2%
Lateral Glenoid Inlay4-6
4.3%
Curved Stem Onlay7
Impact of Accumulating Risk Factors on the Acromial and Scapular Fracture Rate after Reverse Total Shoulder Arthroplasty with a Medialized Glenoid/Lateralized Humerus Onlay Prosthesis
Christopher P. Roche, MSE, MBA; Wen Fan, MS; Ryan Simovitch, MD; Thomas Wright, MD; Pierre-Henri Flurin, MD; Joseph D. Zuckerman, MD; Howard Routman, DO. Impact of Accumulating Risk Factors on the Acromial and Scapular Fracture Rate after Reverse Total Shoulder Arthroplasty with a Medialized Glenoid/Lateralized Humerus Onlay Prosthesis. J. Shoulder Elbow Surg. January 2023. https://doi.org/10.1016/j.jse.2022.12.026.
Identifying risk factors for acromial and scapular fractures improves our understanding about which variables are relevant to this fracture complication; however, this data is difficult to integrate into clinical practice because the majority of rTSA patients have 1 or more risk factors. The goal of this study is to better facilitate preoperative identification of patients at-risk for acromial and scapular fracture and quantify the impact of accumulating risk factors on the incidence of fracture.
We retrospectively analyzed 9,079 rTSA patients from a multi-center database of a single medialized glenoid/lateralized humerus onlay rTSA prosthesis to quantify the rate of acromial and scapular fractures. A univariate and multivariate analysis was performed to identify risk factors for fracture. Next, we quantified the number of patients with one or multiple significant risk factors for fracture. Finally, to facilitate preoperative identification of patients most at-risk for fracture, we stratified our dataset by multiple combinations of age, gender, and diagnosis risk factors and calculated the odds ratio for each cohort to quantify the impact of accumulating risk factors on the incidence of fracture.
138 of 9,079 patients were radiographically identified to have a fracture of the acromion or scapula for a rate of 1.52%. Patients with fractures were more likely older, female, more likely to have a RA diagnosis, CTA diagnosis, and less likely to have diabetes diagnosis. 85% of rTSA patients had at least 1 fracture risk factor. Individually, age, gender, or diagnosis failed to identify any patient cohort with an odds ratio >2.5. Use of multiple combinations of patient risk factors refined identification of at-risk patients better than any individual or 2-risk factor combination and demonstrated that the patients with the greatest fracture risk were females with RA diagnosis >70 years, >75 years, and >80 years.
This 9,079 rTSA multi-center study demonstrated that 1.52% of patients experienced acromial and/or scapular fractures with single medialized glenoid/lateralized humerus onlay rTSA prosthesis. Our analysis identified numerous risk factors and quantified the impact of accumulating risk factors on fracture incidence. Patients considering rTSA with these age, gender, and diagnosis risk factors should be made aware of their elevated complication risk.
- Christopher P. Roche, MSE, MBA; Wen Fan, MS; Ryan Simovitch, MD; Thomas Wright, MD; Pierre-Henri Flurin, MD; Joseph D. Zuckerman, MD; Howard Routman, DO. Impact of Accumulating Risk Factors on the Acromial and Scapular Fracture Rate after Reverse Total Shoulder Arthroplasty with a Medialized Glenoid/Lateralized Humerus Onlay Prosthesis. J. Shoulder Elbow Surg. January 2023. https://doi.org/10.1016/j.jse.2022.12.026.
- Routman, H.D. DO; Simovitch, R.W. MD; Wright, T.W. MD; Flurin, P.H. MD; Zuckerman, J.D. MD; Roche, C.P. MSE, MBA. Acromial and Scapular Fractures After Reverse Total Shoulder Arthroplasty with a Medialized Glenoid and Lateralized Humeral Implant: An Analysis of Outcomes and Risk Factors. J Bone Joint Surg. Article in press. 2020 Aug 26. DOI:10.2106/JBJS.19.00724.
- ASES Complications of RSA Research Group: Mahendraraj KA, Abboud J, Armstrong A, Austin L, Brolin T, Entezari V, et al. Predictors of acromial and scapular stress fracture after reverse shoulder arthroplasty: a study by the ASES Complications of RSA Multicenter Research Group. J Shoulder Elbow Surg. 2021 Oct;30(10):2296-2305. doi:10.1016/j.jse.2021.02.008.
- Levy JC, Anderson C, Samson A. Classification of postoperative acromial fractures following reverse shoulder arthroplasty. J Bone Joint Surg. Am. 2013 Aug 7;95(15):e104.
- Teusink MJ, Otto RJ, Cottrell BJ, Frankle MA. What is the effect of postoperative scapular fracture on outcomes of reverse shoulder arthroplasty? J Shoulder Elbow Surg. 2014 Jun;23(6):782-90. Epub 2013 Dec 8.
- Polisetty T, Cannon D, Grewal G, Vakharia R, Levy JC. Radiographic and anatomic variations on postoperative acromion fractures after inlay and lateralized reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2022 Aug 6:S1058-2746(22)00598-5. doi:10.1016/j.jse.2022.06.020.
- Ascione F, Kilian CM, Laughlin MS, Bugelli G, Domos P, Neyton L, Godeneche A, Edwards TB, Walch G. Increased scapular spine fractures after reverse shoulder arthroplasty with a humeral onlay short stem: an analysis of 485 consecutive cases. J Shoulder Elbow Surg. 2018 Dec;27(12):2183-90. Epub 2018 Aug 8.
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