Characteristic heterotopic ossification of the proximal humerus after total shoulder arthroplasty
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SCIENTIFIC ARTICLE
Characteristic heterotopic ossification of the proximal humerus after total shoulder arthroplasty Erik Olsen 1 & Donald Endrizzi 2 & Matthew Stephenson 1 & Steven Farraher 1 Received: 7 August 2020 / Revised: 13 October 2020 / Accepted: 13 October 2020 # ISS 2020
Abstract Objective A bony spur in a characteristic location involving the proximal humerus is identified on post-operative radiographs in some patients with history of total shoulder arthroplasty. The spur is theorized to represent heterotopic ossification near the attachment site of the pectoralis major tendon on the proximal humerus which is partially detached and then reattached during total shoulder arthroplasty. In this study, we determine the morphology, incidence, demographic associations, and clinical impact of this finding. Materials and methods This is a single-center, retrospective study of 500 patients who underwent total shoulder arthroplasty (250 standard and 250 reverse technique) between 2012 and 2017. Pre- and post-operative shoulder radiographs were reviewed to identify and measure the characteristic spur; inter-observer agreement was evaluated between the two reviewers. Incidence, demographic associations, and clinical significance were then determined. Results The study group included 268 men and 234 women with a mean age of 70 (42–89) years, and clinical follow-up of 25 (1–84) months. Characteristic heterotopic ossification was seen in 88 patients (17.6%) and was first noted radiographically at a mean (interquartile range) of 12.1 (11.5–12.8) months after surgery. Male sex (adjusted odds ratio (95% confidence interval), 3.00 (0.68–5.34), p < 0.001) was independently associated with heterotopic ossification. No significant relationships between heterotopic ossification and adverse clinical outcomes were observed. Conclusion Characteristic heterotopic ossification of the proximal humerus in patients status post total shoulder arthroplasty is a common imaging finding that is not associated with adverse clinical outcomes. Keywords Radiology . Musculoskeletal . Shoulder . Heterotopic ossification . Total shoulder arthroplasty . Proximal humerus . Radiograph . Post-surgical
Introduction
* Erik Olsen [email protected] Donald Endrizzi [email protected] Matthew Stephenson [email protected] Steven Farraher [email protected] 1
Department of Radiology, Maine Medical Center, Portland, ME, USA
2
Department of Surgery, Division of Orthopedics, Maine Medical Center, Portland, ME, USA
Different types of post-operative heterotopic ossification (HO) of the shoulder have been well-described in the literature and typically are centered about the glenohumeral joint space [1–5]. Previous studies have demonstrated that most postoperative HO of the shoulder are benign [1, 3] unlike HO in other joints [6, 7]. It has also been shown that some HO can be misinterpreted as other potentially clinically significant radiographic changes such as scapular notching [1, 8]. These examples indicate the importance of prope
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