Inconsistent reporting of risk factors for acromial stress fractures following reverse total shoulder arthroplasty: a systematic review.
Review
Overview
abstract
BACKGROUND: Acromial stress fractures (ASFs) constitute one of the most common etiologies of impaired clinical outcomes following reverse total shoulder arthroplasty (rTSA). Elucidation of risk factors for ASFs may identify potential targets for preventive measures; however, this reporting may be impeded by inconsistencies across studies. This study aimed to evaluate the variability with which risk factors associated with periprosthetic ASFs following rTSA are ascertained and reported. METHODS: A systematic review was performed by querying PubMed, Embase, and Cochrane computerized databases from their inception through March 2024 to identify clinical outcome studies that reported at least 1 statistically significant risk factor associated with periprosthetic ASF. Risk factors and study characteristics were aggregated. RESULTS: Among 23 studies published from 2013 to 2024, 13 (56.5%) studies diagnosed ASFs by a combination of radiographs (XR) and/or computed tomography. ASFs were diagnosed exclusively with XR in 8 of the 23 studies (34.8%). One study diagnosed ASFs exclusively with computed tomography and another study did not specify the type of imaging modality used. Four studies (17.4%) reported on acromial stress reactions in symptomatic patients with negative XR. Ten studies (43.5%) used a fracture classification system to categorize ASFs, while the remaining 13 studies (56.5%) did not. Among 15 studies that identified patient characteristics as risk factors, osteoporosis (43.5%), female sex (30.4%), and diagnosis of rheumatoid arthritis (30.4%) were most commonly reported. Five studies identified rotator cuff arthropathy as a risk factor (21.7%). Postoperative radiographic parameters describing lateralization and distalization of the center of rotation demonstrated inconsistent associations with ASFs and were confounded by different systems and analysis techniques. CONCLUSIONS: The most commonly cited risk factors for ASFs following rTSA include osteoporosis, rheumatoid arthritis, female sex, and rotator cuff arthropathy. There remain significant discrepancies and inconsistencies in how ASFs following rTSA are defined, diagnosed, and reported on in the literature.
