This multicenter ASES study analyzed 6755 reverse shoulder arthroplasties across 15 institutions. It asked how often symptomatic acromial and scapular spine stress fractures occur, and which preoperative patient factors predict them. Definitions were standardized using a Delphi consensus process to overcome the inconsistency of prior single-center studies.
When you counsel an older woman with cuff arthropathy and osteoporosis for RSA, this paper gives you the numbers: her stress fracture risk is meaningfully elevated on both the bone-quality and cuff-deficiency axes.
The two-theme mental model is the takeaway. Poor bone quality (osteoporosis, inflammatory arthritis, female sex, age) and rotator cuff deficiency (arthropathy, massive tear, chronic dislocation) each independently raise risk. Practically, screen and optimize bone health before elective RSA, and set expectations that a fracture setback most likely appears within the first postoperative year.
Don't over-weight a pre-existing os acromiale or acromial fragmentation. In this cohort neither predicted fracture, and revision surgery did not either. Because this is Level III retrospective data, it defines association not causation, and it only examined preoperative factors. Implant-related contributors like deltoid tensioning remain a separate open question the authors flag for future study.
This multicenter ASES study analyzed 6755 reverse shoulder arthroplasties across 15 institutions. It asked how often symptomatic acromial and scapular spine stress fractures occur, and which preoperative patient factors predict them. Definitions were standardized using a Delphi consensus process to overcome the inconsistency of prior single-center studies.
When you counsel an older woman with cuff arthropathy and osteoporosis for RSA, this paper gives you the numbers: her stress fracture risk is meaningfully elevated on both the bone-quality and cuff-deficiency axes.
The two-theme mental model is the takeaway. Poor bone quality (osteoporosis, inflammatory arthritis, female sex, age) and rotator cuff deficiency (arthropathy, massive tear, chronic dislocation) each independently raise risk. Practically, screen and optimize bone health before elective RSA, and set expectations that a fracture setback most likely appears within the first postoperative year.
Don't over-weight a pre-existing os acromiale or acromial fragmentation. In this cohort neither predicted fracture, and revision surgery did not either. Because this is Level III retrospective data, it defines association not causation, and it only examined preoperative factors. Implant-related contributors like deltoid tensioning remain a separate open question the authors flag for future study.