Saturday, April 16, 2016

Lateral humeral offset in shoulder arthroplasty

Association of lateral humeral offset with functional outcome and geometric restoration in stemless total shoulder arthroplasty

These authors obtained three CT scans on each of 44 patients having stemless total shoulder arthroplasty: (1) preoperative for the osteoarthritic shoulder, (2) for the contralateral healthy shoulder and (3) for the operated shoulder after surgery. They also obtained preoperative and postoperative clinical outcome measures at a minimum follow-up of 12 months (range, 12-50 months).

They measured lateral humeral offset (LHO) as the distance between the medial edge of the base
of the coracoid process and the most lateral border of the greater tubercle. 


 The postoperative difference in LHO between the operated shoulder after surgery and contralateral healthy shoulder was 1.3 ± 4.6 mm. Lengthening of LHO was associated with worsening shoulder function at 3 months but not at 12 months. 

Comment: Determining the position of the tuberosity in relation to the scapula is a helpful tool for assessing (a) the degree of medial erosion preoperatively and (b) the degree to which the tuberosity is lateralized after surgery (recognizing that excessive tuberosity lateralization can placed increased tension on the rotator cuff, "overstuffing").

Rather than obtaining CT scans we use the lateral acromial line on the plain film AP in the plane of the scapula (Grashey view) to indicate the relative position of the tuberosity and scapula as shown in two different patients below.


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