Acromial insufficiency in reverse shoulder arthroplasties.
OBJECTIVE
Reverse shoulder prostheses depend on deltoid function. An injury to the acromion, either fracture or meso-acromion, or deltoid injury, may affect the outcomes of patients after receiving a reverse shoulder prosthesis.


METHODS
Four-hundred and fifty-seven consecutive reverse shoulder prostheses were implanted between January 1992 and June 2003 by one of seven surgeons in five separate centers. Forty-one patients were noted to have a pre-operative lesion of the acromion or scapular spine. Twenty-three presented with an os acromiale (meso-acromion). Seventeen had fracture or fragmentation of the acromion. One patient had a pseudarthrosis of the scapular spine.


RESULTS
Preoperative acromial pathology, surgical approach, and amount of inferior acromial tilt did not diminished postoperative range of motion, Constant score, or subjective results when compared to patients without acromial pathology. In contrast, the four patients with postoperative acromial spine fractures had inferior results with respect to functional and subjective results.


CONCLUSIONS
Preoperative acromial lesions are not a contraindication to reverse shoulder arthroplasty. Postoperative fracture of the acromial spine has a significant effect on results and treatment is uncertain.
Walch
Gilles
G
Centre Orthopédique Santy, 24 Avenue Paul Santy, F-69008 Lyon, France. socoly@free.fr
Mottier
Franck
F
Wall
Bryan
B
Boileau
Pascal
P
Molé
Daniel
D
Favard
Luc
L
D000174:Acromion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011300:Preoperative Care; D011336:Probability; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D020069:Shoulder Pain / Q000209:etiology* / Q000601:surgery; D018709:Statistics, Nonparametric