April 17, 2019
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Subscapularis tenotomy, lesser tuberosity osteotomy had comparable outcomes for TSA

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William N. Levine

Patients undergoing total shoulder arthroplasty with either subscapularis tenotomy or lesser tuberosity osteotomy had comparable successful subjective and objective clinical outcomes, according to results.

“Over the last decade there was controversy regarding the best approach for shoulder arthroplasty—subscapularis tenotomy vs. lesser tuberosity osteotomy with proponents on both sides of the equation (often done in a retrospective, non-randomized fashion),” William N. Levine, MD, co-author of the study, told Healio.com/Orthopedics. “Therefore, we initiated a prospective, randomized trial to better understand if there was a significant difference for our patients.”

Levine and colleagues randomly assigned 60 shoulders with primary osteoarthritis undergoing total shoulder arthroplasty (TSA) to either the subscapularis tenotomy group (n=30) or the lesser tuberosity osteotomy group (n=30). Researchers collected preoperative and 6-week, 3-month, 6-month and 1-year postoperative data. Operative time, tenotomy or osteotomy repair time and osteotomy thickness were included in the intraoperative data. Ultrasound and radiographs were used in the tenotomy and osteotomy groups, respectively, to evaluate healing at 3 months.

Results showed the two groups had no significant differences in range of motion or clinical outcomes at baseline or 1 year postoperatively. Patients in the subscapularis tenotomy group had a significantly shorter mean total case duration, as well as a significantly shorter repair time vs. the lesser tuberosity osteotomy group, researchers noted. According to results, 93.1% of shoulders in the lesser tuberosity osteotomy group showed bone-to-bone healing on radiographs at final follow-up and 86.7% of shoulders in the subscapularis tenotomy group had no full-thickness tears on ultrasound at 3 months.

“After completing this study, we feel comfortable in concluding that both approaches are acceptable and one is not superior to the other,” Levine said. “Complications can occur with either approach but in general, they both lead to reproducible results in the majority of the patients undergoing shoulder arthroplasty.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.