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Subscapularis-Sparing Approaches In Shoulder Arthroplasty: A Systematic Review

2021 Congress Paper Abstracts

Subscapularis-Sparing Approaches In Shoulder Arthroplasty: A Systematic Review

Sandra Lee, BSc (Cand), CANADA Huda Sardar, BSc (Cand), CANADA Nolan Horner, MD, CANADA Latifah Al Mana, MBBS, CANADA Bruce S. Miller, MD, MS, UNITED STATES Moin Khan, MD, MSc, FRCSC, CANADA Bashar Alolabi, MD, MSc, FRCSC, CANADA

McMaster University, Hamilton, ON, CANADA


2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Treatment / Technique

Sports Medicine

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Summary: The findings of this review suggest that the SSC-sparing approach in aTSA or rTSA provides significant improvements in shoulder function and mobility.


Objective

Subscapularis (SSC) dysfunction is a widely recognized complication following shoulder arthroplasty. SSC-sparing approaches for anatomic total should arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) have been recently described. This systematic review aims to summarize the outcomes of SSC-sparing aTSA and rTSA in comparison to traditional approaches involving SSC takedown.

Data Sources: Medline, Embase, PubMed, and CENTRAL databases were searched for studies evaluating any outcomes on SSC-sparing approaches in rTSA or aTSA. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool for randomized studies and the MINORS tool for non-randomized studies.

Main Results: From 2,051 retrieved citations, 8 eligible studies (n=309) were analyzed. Six studies performed aTSA and 2 studies performed rTSA. Average follow-up period was 1-2 years for clinical outcomes and 2-6 weeks for radiographic outcomes. For SSC-sparing aTSA and rTSA, all studies reported significant improvements in shoulder function and range of motion following surgery. However, when comparing SSC-sparing to a traditional approach, these improvements were insignificant across multiple outcome measures, with the exception of forward flexion in SSC-sparing rTSA. The SSC-sparing approach was associated with significantly more frequent and bigger retained osteophytes. Of patients who had humeral head diameter measurement discrepancies of greater than 4 mm, 23% were SSC-sparing compared to 8% traditional for aTSA. Risk of revision surgery and complications were similar between SSC-sparing and traditional approaches for both aTSA and rTSA.

Conclusions

The findings of this review suggest that the SSC-sparing approach in aTSA or rTSA provides significant improvements in shoulder function and mobility. In comparison to a traditional SSC takedown approach, the SSC-sparing approach may provide better improvements in early forward flexion in rTSA. However, improvements in functional outcomes and range of motion were not significantly different between traditional and SSC-sparing TSA at 1- to 2-year follow-up. The main concern for SSC-sparing TSA is reduced exposure of the shoulder joint, which may cause residual postoperative osteophytes and discrepancies between the native humeral head and prosthesis. However, this does not appear to negatively impact clinical outcome for up to 2-years post-surgery.


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