RADIOLOGICAL IMPACT OF SURGICAL DELAYS FOR PATIENTS WAITING FOR AN ELECTIVE SHOULDER ARTHROPLASTY SURGERY

It has been established in previous literature that surgical delays can lead to technically more difficult surgeries with higher risk of complications and poorer outcomes. The purpose of this study is to compare shoulder CT images of patients at the time of their inclusion on the waiting list for a shoulder arthroplasty surgery and after at least one year of delay. The objective is to determine whether surgical delay could cause radiological deterioration significant enough that it could impair patient outcomes. The hypothesis is that humeral head and glenoid bone densities would be lower on the follow-up scan. Also, measurements of humeral retroversion, humeral head subluxation, and glenoid radius would be worse on the follow-up CT. A retrospective and current review of surgical waiting lists identified patients awaiting shoulder arthroplasty surgery (anatomic or reverse). Patients underwent control shoulder scan at 1-year interval following inclusion on the surgical waiting list. Data from both scans were subjected to comparative statistical analysis. Twenty-seven patients met the inclusion criterias for this study (seven men, 20 women; mean age 66.89 years (35–84)). Common indication for arthroplasty included osteoarthritis (11 (40.74%)), rotator cuff arthropathy (6 (22.22%)), rheumatoid arthritis (5 (18.52%) and osteoarthritis secondary to instability (3 (11.11%)). Thirteen patients (48,15%) were consented for anatomic total shoulder arthroplasty, 14 patients (51,85%) were consented for a reverse total shoulder arthroplasty. Wear measurements of humeral retroversion, humeral head subluxation and glenoid radius were not significantly different on the control CT scan (p= 0.438, 0.692 and 0.999). Bone density values of the humeral head were significantly lower on control CT in all three planes (p < 0.001). Bone density values for the subchondral glenoid were also statistically lower on control CT (p < 0.001). Subchondral glenoid bone density was also significantly lower on control CT (p=0.036). When comparing patients’ diagnosis, the patients diagnosed with rotator cuff arthropathy and rheumatoid arthritis did not have significantly different bone density at the glenoid and humeral head, in contrast with patients diagnosed with primary osteoarthritis. The results demonstrate that at one year after inclusion on a waiting list for shoulder arthroplasty surgery, patients have significantly lower bone density values at the humeral head and glenoid. These results could be attributable to non-usage and could potentially results in surgeries at higher risk of complications. Patients suffering from osteoarthritis are at the greatest risk of having a significant decrease in bone density at 1 year when compared to other diagnosis. Finally, Wear measurements were not statistically different, which implies that it would require serial control scans to identify impactful deterioration. Further studies will be needed to serially assess radiological deterioration and to correlate surgical delay to radiological and functional post-operative outcomes.