Comparing Two Surgical Methods of Fixation of Subscapularis During Shoulder Arthroplasty

The study investigates the difference in disease specific quality of life between patients who undergo a subscapularis peel versus morselized osteotomy of the lesser tuberosity, as measured by the Western Ontario Osteoarthritis of the Shoulder (WOOS) at one year post-operatively in patients who undergo shoulder arthroplasty ?

• subscapularis peel (Procedure), also known as non applicable: Detachment of the subscapularis tendon from its insertion on the lesser tuberosity "the peel".
• osteotomy (Procedure), also known as non applicable: This group will use a technique that involves elevation of the tendon with a wafer of bone in order to gain access to the shoulder.

Primary outcomes

• Subscapularis Strength [2 years]: Subscapularis muscle strength will be measured with an electronic handheld dynamometer. Patients are asked to press the dynamometer in towards their chest (belly-press) for a period of approximately 3 seconds before releasing. Strength is measured in kilograms of force.

Secondary outcomes

• Western Ontario Osteoarthritis of the Shoulder Index [2 Years]: The Western Ontario Osteoarthritis of the Shoulder Index (WOOS) is a disease specific evaluation, proven to be an accurate and valid assessment of function after shoulder replacement. The WOOS is a patient-reported measure, 19-question survey. Each question is measured using a visual analog scale rated from 0-100, where higher scores mean better outcome.
• American Shoulder and Elbow Score [2 Years]: The ASES is a shoulder specific assessment divided into two sections: pain and activities of daily living (ADL). Pain is recorded on a visual analogue scale (0-10), lower scores indicate better outcomes. There are 10 activities of daily living questions, each are recorded on a 4 level likert scale (0-3), which a higher score indicates a better outcome. The overall score is an equal weight of the two sections and produces a score out of 100. The higher the score, the better the outcome.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Patients who have failed standard non-surgical management of their shoulder arthritis who would benefit from a shoulder arthroplasty.

Exclusion Criteria:

* Active joint or systemic infection
* Significant muscle paralysis
* Rotator cuff tear arthroplasty
* Major medical illness
* Unable to speak or read English/French
* Psychiatric illness that precludes informed consent
* Unwilling to be followed for 1 year

Participant flow

Outcome results

• Subscapularis Strength (Primary), Mean, kg: Osteotomy 4.4 +/- 2.9; Subscapularis Peel 5.5 +/- 2.6
• Western Ontario Osteoarthritis of the Shoulder Index (Secondary), Mean, WOOS Score: Osteotomy 86.5 +/- 16; Subscapularis Peel 88.2 +/- 16.5
• American Shoulder and Elbow Score (Secondary), Mean, ASES Score: Osteotomy 79.4 +/- 24.6; Subscapularis Peel 83.3 +/- 19

Adverse events

Time frame: Adverse events were monitored through to participant study completion up until 2-years post-operative

• Results publication: Lapner PL, Sabri E, Rakhra K, Bell K, Athwal GS. Healing rates and subscapularis fatty infiltration after lesser tuberosity osteotomy versus subscapularis peel for exposure during shoulder arthroplasty. J Shoulder Elbow Surg. 2013 Mar;22(3):396-402. doi: 10.1016/j.jse.2012.05.031. Epub 2012 Sep 1. PMID 22944077
• Results publication: Lapner PL, Sabri E, Rakhra K, Bell K, Athwal GS. Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012 Dec 19;94(24):2239-46. doi: 10.2106/JBJS.K.01365. PMID 23318614

• Peter Lapner, MD, Principal investigator, OHRI