Bone Density Changes at the Origin of the Deltoid Muscle following Reverse Shoulder Arthroplasty.
Antonio CaldariaEdoardo Giovannetti de SanctisLuca SacconeAngelo BaldariDanila AzzolinaLuca La VerdeAlessio PalumboFrancesco FranceschiPublished in: Journal of clinical medicine (2024)
Background: Reverse total shoulder arthroplasty (RSA) significantly impacts deltoid length, tension, and structure. Studies have extensively investigated various modifications in deltoid characteristics, such as perfusion, elasticity, caliber, histological changes, and strength post-RSA. However, to date, there is a notable absence of research evaluating changes in bone mineral density (BMD) at the deltoid muscle origin after the RSA procedure. Methods: A retrospective analysis of a consecutive series of RSAs performed between May 2011 and May 2022 was conducted. Inclusion criteria comprised primary RSAs with both preoperative and last follow-up shoulder CT scans and a minimum follow-up of 12 months. Trabecular attenuation measured in Hounsfield units (HU) was calculated using a rapid region-of-interest (ROI) method. BMD analysis involved segmenting three ROIs in both pre- and postoperative CT scans of each patient: the acromion, clavicle, and spine of the scapula. Results: A total of 44 RSAs in 43 patients, comprising 29 women and 14 men, were included in this study. The mean follow-up duration was 49 ± 22.64 months. Significant differences were observed between preoperative and postoperative HU values in all analyzed regions. Specifically, BMD increased in the acromion and spine, while it decreased in the clavicle ( p -values 0.0019, <0.0001, and 0.0088, respectively). Conclusions: The modifications in shoulder biomechanics and, consequently, deltoid tension post-implantation result in discernible variations in bone quality within the analyzed regions. This study underscores the importance of thorough preoperative patient planning. By utilizing CT images routinely obtained before reverse shoulder replacement surgery, patients at high risk for fractures of the acromion, clavicle, and scapular spine can be identified.
Keyphrases
- bone mineral density
- computed tomography
- patients undergoing
- contrast enhanced
- postmenopausal women
- end stage renal disease
- ejection fraction
- body composition
- newly diagnosed
- chronic kidney disease
- minimally invasive
- case report
- prognostic factors
- magnetic resonance imaging
- positron emission tomography
- type diabetes
- magnetic resonance
- pregnant women
- multidrug resistant
- patient reported outcomes
- machine learning
- metabolic syndrome
- deep learning
- insulin resistance
- coronary artery disease
- percutaneous coronary intervention
- polycystic ovary syndrome
- atomic force microscopy
- quantum dots
- optical coherence tomography
- rotator cuff
- middle aged
- coronary artery bypass
- convolutional neural network