Reverse total shoulder and heterotopic bone at the inferior glenoid

Heterotopic ossification of the long head of the triceps after reverse total shoulder arthroplasty.

These authors reviewed 164 patients having a reverse shoulder arthroplasty performed between 2008 and 2012. They found heterotopic ossification (HO) inferior to the glenoid in 61.6%. In 23.2% of the cases there was contact between the HO and the humerus, 3.0% appeared ankylosed.  14.6% of the cases had scapular notching.

Male and female HO rates were 74.0% and 56.1%, respectively (P = .0304). Patients with HO had less forward elevation (121°) than those without HO (133°, P = .0087).

Comment: The rate of HO in this series is somewhat higher than we might expect. The underlying cause for this increased rate of HO in reverse shoulder arthroplasty is not clear. It is possible that the surgical technique used included release of the soft tissues from the inferior glenoid with resultant stimulation of new bone formation. Erosion of the lateral glenoid neck by the humeral prosthesis ("scapular notching") with the Grammont-style implant may release bits of bone into the area that contribute to heterotopic bone formation.

The x-rays shown below demonstrate the variety of patterns of heterotopic bone formation after reverse total shoulder arthroplasty.

We suggest that the risk of HO may be reduced through the use of a more laterally offset glenosphere that avoids contact between the humeral component and the lateral scapula, by avoiding irritating the bone at the lateral scapula when performing soft tissue releases around the glenoid, and by thorough irrigation to remove any bone fragments that may have resulted from preparation for the implants.

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Naproxen after joint surgery

Effect of Naproxen Prophylaxis on Heterotopic Ossification Following Hip Arthroscopy: A Double-Blind Randomized Placebo-Controlled Trial.

These authors performed a Level I study to determine the effect of postoperative naproxen therapy on the development of unwanted bone formation (HO) following arthroscopic surgery for femoroacetabular impingement.

Those in the treatment group were prescribed 500 mg of Naproxen twice a day. The prevalence of HO was 46% in the control group versus 4% in the naproxen group.  Minor adverse reactions to the study medications were reported in 42% of the patients taking naproxen versus 35% of those taking the placebo (p = 0.45).

Comment: While the shoulder is not the hip, and femoroacetabular impingement surgery is not arthroplasty, we are interested in the use of Naproxen as a means of increasing comfort and decreasing stiffness after shoulder arthroplasty. In the past we avoided anti-inflammatory medications (NSAIDs) after shoulder arthroplasty out of concern for bleeding and delayed healing. Currently, however, Naproxen has become a part of our postoperative program. Our initial observations are that the postoperative course is smoother for the patient and we've not observed significant side effects.
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Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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