Osseous changes following reverse total shoulder arthroplasty combined with latissimus dorsi transfer: A Case Series

Abstract Background First report on the incidence of proximal humerus osseous changes and associated clinical consequences in reverse total shoulder arthroplasty combined with a latissimus dorsi tendon transfer (RTSA+LDT). Methods A multi-center, retrospective review identified all patients who had undergone a primary RTSA+LDT and had at least 3-month radiographic follow-up between 2012-2017. Data collection included demographics, oral steroid use, repair technique for LDT fixation, radiographic humeral osseous changes, complications and need for revision surgery. Results Twenty-four patients were included with an average age of 70.7±7.9 years and follow-up of 16.3 (3-50) months. Ten patients (41.7%) developed osseous changes at the transfer location. There was no increased risk of developing osseous changes based on surgical fixation technique (p=0.421). Average time to earliest radiographic detection of osseous changes was 2.7±1.7 months, with all changes happening at or before 6-months. Two patients developed proximal humerus fractures, of which one had osseous changes through which the fracture occurred. Discussion RTSA+LDT may place the proximal humeral cortex at greater risk than previously described. Utilizing a long-stem prosthesis in the setting of RTSA+LDT may limit the consequences of this complication.