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Cho SH, Park CJ, Kim SJ, Lee KG, Baek GR, Lew R, Hui AT, McGarry MH, Lee TQ, Ok J, Kim YS. How important is the teres minor in reverse total shoulder arthroplasty combined with latissimus dorsi transfer? J Shoulder Elbow Surg 2025:S1058-2746(25)00170-3. [PMID: 39988238 DOI: 10.1016/j.jse.2025.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 01/07/2025] [Accepted: 01/11/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND The utility of latissimus dorsi (LD) transfer combined with reverse total shoulder arthroplasty to restore external rotation (ER) strength is clinically well-established, but studies directly comparing LD and intact teres minor (TM) strength are lacking. Also, variations in eccentricity in the glenoid components have been under-estimated. METHODS We used 8 fresh-frozen cadaveric shoulders in this study. LD transfer to the posterolateral aspect of the greater tuberosity was simulated using a cable pulley system. We explored 6 possible conditions: massive rotator cuff tears (RCTs) (supraspinatus and infraspinatus tears), massive RCTs with TM tears, massive RCTs with TM tears and LD transfer, and all 3 conditions complicated by concentric and eccentric glenoid components. We measured the impingement-free range of motion, the ER torque (N∗m), the maximum abduction angle on successive loading of the middle deltoid (the abduction capacities), and the anterior dislocation forces. RESULTS Use of an eccentric glenosphere was associated with greater impingement-free range of motion in all directions, but the differences in ER strength, abduction capability, and anterior dislocation force compared with a concentric design were not significant. LD transfer with TM tears showed significantly greater ER strength than massive RCTs condition at 30° (P < .05) and 60° (P < .05) of abduction. TM tears, with or without LD transfer, had less anterior stability than an intact TM (P < .05). Massive RCTs combined with TM tears tended to be associated with an increased abduction angle under the same deltoid load across all tested loads, revealing the key role played by the TM in joint stability and ER. CONCLUSIONS LD transfer enhanced ER abduction strength in the absence of an intact TM, in contrast to a massive RCT with an intact TM. The TM was found to play a significant role in stability. Greater range of motion in all directions was achieved with an eccentric rather than with a concentric glenosphere.
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Affiliation(s)
- Sung-Hyun Cho
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan-Joo Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Jae Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung-Geun Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gyu Rim Baek
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Los Angeles, CA, USA
| | - Ryan Lew
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Los Angeles, CA, USA
| | - Aaron T Hui
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Los Angeles, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Los Angeles, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Los Angeles, CA, USA
| | - Jihoon Ok
- Seokbawi Orthopedics Clinic, Incheon, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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García-Fernández C, Lopiz Y, Garríguez-Pérez D, Arvinius C, Ponz V, Echevarria M, Garrido A, Marco F. Do the humeral radiographic changes at 5-year follow-up affect the clinical outcomes of press-fit humeral stems in primary reverse shoulder arthroplasties? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1851-1863. [PMID: 38431896 DOI: 10.1007/s00590-024-03864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The purposes of this study were to analyze and compare the functional outcomes and radiological changes around the press-fit humeral components in two contemporary medialized reverse total shoulder arthroplasty (RTSA) systems at a minimum of 5-year follow-up. MATERIALS AND METHODS Between December 2003 and December 2015, 249 consecutive RTSAs were performed at our hospital. Of these, 68 primary uncemented RTSA met our inclusion criteria. The Constant-Murley score (CMS), the modified Constant score, a visual analog scale (VAS) and active shoulder range of motion (ROM) were measured pre- and postoperatively. Radiological assessment was performed by plain radiographs at a minimum of 5 years postoperatively. RESULTS At a mean follow-up of 80.2 months, there was no significant difference (p = .59) between the postoperative functional scores and range of motion of the two groups (Delta Xtend and Lima SMR). Radiological data of stress-shielding were observed in 38 patients (55.9%) being slightly more frequent in the Lima SMR group (21 patients) than in the Delta Xtend group (17 patients) (p = .62). CONCLUSIONS Our study shows that the good functional results are similar between the two uncemented RTSA systems used and that they do not depend on the presence of radiological changes (stress-shielding) in the humeral stem at a minimum 5-year follow-up.
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Affiliation(s)
- Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain.
| | - Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
- Department of Surgery, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Daniel Garríguez-Pérez
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Camilla Arvinius
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Virginia Ponz
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Marta Echevarria
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Ana Garrido
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Clínico San Carlos, C/Profesor Martín Lagos S/N, 28040, Madrid, Spain
- Department of Surgery, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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Yamada E, Kozono N, Nabeshima A, Tashiro E, Nakashima Y. Baseplate inferior offset affects shoulder range of motion in reverse shoulder arthroplasty in Asian population. J Orthop Surg Res 2024; 19:25. [PMID: 38167444 PMCID: PMC10762829 DOI: 10.1186/s13018-023-04506-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Impingement is a common complication of reverse shoulder arthroplasty. Placement of the baseplate with a wide impingement-free angle is ideal; however, there are few studies on Asian populations, which have smaller height and physique, and there is a lack of guidance on achieving optimal outcomes. The purpose of the present study was to explore the impingement-free range of motion reverse shoulder arthroplasty and analyze the suitable baseplate position or tilt for the Asian population using simulation software. METHODS We uploaded computed tomography scan data from 20 Asian patients to three-dimensional (3D) simulation software. The implantation of the reverse shoulder arthroplasty component was performed on the 3D humerus and scapula using software, and range of motion was assessed until impingement occurred. RESULTS The range of motion in flexion significantly improved when the baseplate was lowered up to 3 mm inferiorly. Range of motion in abduction and internal and external rotation significantly improved as the baseplate was lowered up to 4 mm. There was no significant difference in range of motion in any motion after changing the inferior tilt, except in internal and external rotation. CONCLUSIONS The range of motion in abduction, flexion, and internal and external rotations significantly improved with increased inferior offset. These results may prove valuable in determining the optimal baseplate position for RSA, particularly in Asian populations.
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Affiliation(s)
- Erina Yamada
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Naoya Kozono
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Eiji Tashiro
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Xu X, Sun Q, Liu Y, Wang D, Diao S, Wang H, Gao Y, Lu T, Zhou J. Comparative Analysis of Eccentric Glenosphere in Reverse Total Shoulder Arthroplasty: A Computer Simulation Study. Int J Gen Med 2023; 16:4691-4704. [PMID: 37868817 PMCID: PMC10590075 DOI: 10.2147/ijgm.s426191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/16/2023] [Indexed: 10/24/2023] Open
Abstract
Objective The aim was to evaluate the effects of different glenosphere eccentricities on impingement, range of motion (ROM), and muscle length during standard activities in reverse total shoulder arthroplasty (RSA). Methods In this study, we utilized computational modeling techniques to create native shoulder and shoulder models undergoing RSA and simulate shoulder movements in all abduction-adduction, flexion-extension, and rotation. We tested a total of 36 different glenosphere configurations, which included three different inferior tilts (0°, +10°, +20°) and two different lateral offsets (0 mm and +4 mm), as well as six different glenosphere eccentricities (concentricity, inferior, posterior, anterior, anteroinferior, and posteroinferior). We evaluated the maximum impingement-free ROM, impingement sites, and muscle lengths. Results All glenosphere configurations exceeded 50% of native shoulder ROM in three planes and total global ROM. In abduction-adduction, there was no significant difference among the different glenosphere eccentricities (p > 0.05). In flexion-extension, the posteroinferior eccentricity had the maximum ROM among the different eccentricities, but no significant difference among the different glenosphere eccentricities (p > 0.05). In rotation, there was a significant difference overall, and anteroinferior eccentricity had a significant advantage over concentricity (p < 0.05). In total global ROM, anteroinferior eccentricity had a significant advantage over concentricity when lateral offset was 0 mm (p < 0.05). In all models of glenosphere eccentricities, only the elongation of the infraspinatus muscle was statistically significant (p < 0.05). Conclusion Glenosphere eccentricity significantly influenced rotation, total global ROM, and the length of the subscapularis muscle. Among them, anteroinferior offset achieved the maximum ROM in abduction-adduction, rotation, and total global activities. Both anteroinferior and inferior glenoid eccentricity showed significant advantages over the concentricity in rotation and total global ROM. Level of Evidence Basic Science Study; Computer Modeling.
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Affiliation(s)
- Xiaopei Xu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Qingnan Sun
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Dong Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Shuo Diao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Hanzhou Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Yuling Gao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Tianchao Lu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Junlin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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Holschen M, Körting M, Khourdaji P, Bockmann B, Schulte TL, Witt KA, Steinbeck J. Treatment of proximal humerus fractures using reverse shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical outcome and tuberosity healing? Arch Orthop Trauma Surg 2022; 142:3817-3826. [PMID: 34977963 DOI: 10.1007/s00402-021-04281-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The employment of reverse shoulder arthroplasty for dislocated proximal humerus fractures of elderly patients becomes increasingly relevant. The standard inclination angle of the humeral component was 155°. Lately, there is a trend towards smaller inclination angles of 145° or 135°. Additionally, there has been an increased focus on the lateralization of the glenosphere. This retrospective comparative study evaluates clinical and radiological results of patients treated for proximal humerus fractures by reverse shoulder arthroplasty with different inclination angles of the humeral component, which was either 135° or 155°. Additionally, a different lateral offset of the glenosphere, which was either 0 mm or 4 mm, was used. METHODS For this retrospective comparative analysis, 58 out of 66 patients treated by reverse total shoulder arthroplasty for proximal humerus fractures were included. The minimum follow-up was 24 months. Thirty (m = 3, f = 27; mean age 78 years; mean FU 35 months, range 24-58 months) were treated with a standard 155° humeral component and a glenosphere without lateral offset (group A), while 28 patients (m = 2, f = 26; mean age 79 years; mean FU 30 months, range 24-46 months) were treated with a 135° humeral component and a glenosphere with a 4 mm lateral offset (group B). We determined range of motion, Constant score, and the American Shoulder and Elbow Surgeons Shoulder score as clinical outcomes and evaluated tuberosity healing as well as scapula notching. RESULTS Neither forward flexion (A = 128°, B = 121°; p = 0.710) nor abduction (A = 111°, B = 106°; p = 0.327) revealed differences between the groups. The mean Constant Score rated 63 in group A, while it was 61 in group B (p = 0.350). There were no differences of the ASES Score between the groups (A = 74, B = 72; p = 0.270). There was an increased risk for scapula notching in group A (47%) in comparison to group B (4%, p = 0.001). Healing of the greater tuberosity was achieved in 57% of group A and in 75% of group B (p = 0.142). The healing rate of the lesser tuberosity measured 33% in group A and 71% in group B (p = 0.004). CONCLUSIONS Both inclination angles of the humeral component are feasible options for the treatment of proximal humerus fractures in elderly patients. Neither the inclination angle nor the lateral offset of the glenosphere seem to have a relevant influence on the clinical outcome. The healing rate of the lesser tuberosity was higher in implants with a decreased neck-shaft angle. There is an increased risk for scapula notching, if a higher inclination angle of the humeral component is chosen. LEVEL OF EVIDENCE III. Retrospective comparative study.
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Affiliation(s)
- Malte Holschen
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany.
- Raphaelsklinik, Loerstr. 23, 48143, Münster, Germany.
| | - Maria Körting
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | | | - Benjamin Bockmann
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias L Schulte
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kai-Axel Witt
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
| | - Jörn Steinbeck
- Orthopedic Practice Clinic (OPPK), Von-Vincke-Str. 14, 48143, Münster, Germany
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Al Yaseen M, Smart YW, Seyed-Safi P, Abdelmonem AH, Makki D, Morgan B, Sandher D. Effect of Implant Size, Version and Rotator Cuff Tendon Preservation on the Outcome of Reverse Shoulder Arthroplasty. Cureus 2022; 14:e25741. [PMID: 35812581 PMCID: PMC9263422 DOI: 10.7759/cureus.25741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Functional outcomes following reverse geometry shoulder arthroplasty can vary. This study assessed the effects of glenosphere size, humeral stem version, posterior rotator cuff status and subscapularis repair on patient-reported outcome and range of motion. Methods: A consecutive series of 132 patients from two orthopaedic centres that use the same onlay system for reverse shoulder arthroplasty were reviewed over a six-year period. Outcome measures consisted of the Oxford Shoulder score (OSS) and range of motion (ROM) at one year following surgery. These were assessed against glenosphere sizes (small (36-38 mm) and large (40-42 mm)), humeral stem retroversion (less or more than 20 degrees), rotator cuff status (posterior rotator cuff present or absent) and subscapularis tendon (repaired or not) at the end of procedure. Results: Larger glenospheres and less humeral stem retroversion yielded better ROM and OSS but this was not statistically significant. Subscapularis repair had no effect on outcomes. Preservation of posterior rotator cuff tendons improved functional outcomes. The number of tendons present at the end of procedure had a positive effect on outcome (best with two tendons and better with one compared to a completely bald humeral head). Conclusion: Preservation of posterior rotator cuff tendons during reverse shoulder arthroplasty improves clinical outcomes unlike subscapularis repair which was found to be unnecessary. Implant size and version in reverse geometry arthroplasty have no significant effects on clinical outcome.
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Haidamous G, Lädermann A, Hartzler RU, Parsons BO, Lederman ES, Tokish JM, Denard PJ. Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty. Shoulder Elbow 2022; 14:39-47. [PMID: 35154401 PMCID: PMC8832695 DOI: 10.1177/1758573220936234] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose was to evaluate the relationship of component size and position to postoperative range of motion following reverse shoulder arthroplasty. The hypothesis was that increased lateralization, larger glenospheres, and a decreased acromiohumeral distance would be associated with excellent postoperative range of motion. METHODS A retrospective multicenter study was performed at a minimum of one year postoperatively on 160 patients who underwent primary reverse shoulder arthroplasty with a 135° humeral component. Outcomes were stratified based on postoperative forward flexion and external rotation into excellent (n = 42), defined as forward flexion >140° and external rotation > 30°, or poor (n = 36), defined as forward flexion <100° and external rotation < 15°. Radiographic measurements and component features were compared between the two groups. RESULTS A larger glenosphere size was associated with an excellent outcome (p = 0.009). A 2-mm posterior offset humeral cup (p = 0.012) and an increased inferior glenosphere overhang (3.1 mm vs 1.4 mm; p = 0.002) were also associated with excellent outcomes. Humeral lateralization and distalization were not associated with an excellent outcome.Conclusion: Larger glenosphere size and inferior positioning as well as posterior humeral offset are associated with improved postoperative range of motion following reverse shoulder arthroplasty. LEVEL OF EVIDENCE Level 3, retrospective comparative study.
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Affiliation(s)
| | - Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | | | | | - Evan S Lederman
- University of Arizona College of Medicine Phoenix and the Orthopedic Clinic Association, Phoenix, AZ, USA
| | | | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA,Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA,Patrick J Denard, Southern Oregon Orthopedics, 2780 E. Barnett Road, Suite 200, Medford, OR 97530, USA.
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Collotte P, Bercik M, Vieira TD, Walch G. Long-term Reverse Total Shoulder Arthroplasty Outcomes: The Effect of the Inferior Shifting of Glenoid Component Fixation. Clin Orthop Surg 2021; 13:505-512. [PMID: 34868500 PMCID: PMC8609210 DOI: 10.4055/cios20245] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Backgroud The 155° Grammont reverse shoulder replacement has a long track record of success, but also a high radiographic notching rate. The increased distance between the scapular pillar and the humeral component theoretically decreases postoperative notching. The glenoid component can be shifted inferiorly relative to the glenoid; however, there also is some concern that shifting the glenoid component too far inferiorly (inferior glenoid component overhang > 3.5 mm) may compromise long-term stability of the glenoid component. This study was conducted to determine if clinical outcomes, scapular notching, and complications vary with more inferior placement of the glenoid component. Methods A retrospective analysis of prospectively collected data was performed in order to compare radiographic outcomes (notching rate and signs of glenoid loosening or component disassembly) and clinical outcomes (range of motion, Constant score, subjective shoulder value, and complication rate) of all patients who underwent reverse shoulder replacement with the glenosphere positioned either flush with the inferior rim of the glenoid (flush group) or with at least 3.5 mm of inferior overhang (overhang group) at a minimum follow-up of 60 months. Ninety-seven patients ultimately met the inclusion criteria, with 41 patients with flush glenoid component and 56 patients with at least 3.5 mm of inferior overhang. Results Average follow-up was 97.8 months. The overhang group had a lower rate of radiographic notching (37% vs. 82.5%, p < 0.05), better clinical outcomes (improvement in Constant score: +40 vs. +32, p = 0.036), and higher subjective shoulder value (79 vs. 69, p = 0.026) than the flush group. No difference in complications between groups was found. Conclusions In this study, at least 3.5 mm of inferior glenosphere overhang relative to the inferior rim of the glenoid was associated with the lower notching rate without negative effect on the clinical outcomes in 155° Grammont-style reverse shoulder replacement. Therefore, no increase in complications should be expected when using this surgical technique.
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Affiliation(s)
- Philippe Collotte
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hopital Prive Jean Mermoz, Lyon, France
| | | | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hopital Prive Jean Mermoz, Lyon, France
| | - Gilles Walch
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hopital Prive Jean Mermoz, Lyon, France
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Collotte P, Erickson J, Vieira TD, Domos P, Walch G. Clinical and radiologic outcomes of eccentric glenosphere versus concentric glenosphere in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:1899-1906. [PMID: 33276160 DOI: 10.1016/j.jse.2020.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of an eccentric glenosphere (EG) has been proposed as a way to prevent scapular notching in reverse shoulder arthroplasty (RSA). The purpose of this study was to investigate whether the use of an EG decreases scapular notching compared with matched standard concentric glenosphere (CG) controls. METHODS A retrospective analysis was performed. This study included 49 RSAs with an EG and 49 paired RSAs with a CG with a minimum 60 months of both clinical and radiographic follow-up. Clinical and radiologic outcomes of the EG and CG groups were compared at inclusion and at the last follow-up using the paired Student t test for quantitative data and the χ2 test for qualitative data. Scapular notching was graded according to the Sirveaux classification. Statistical significance was set at P < .05. RESULTS Notching was observed 2.7 times (95% confidence interval, 1.0-6.8 times) more often in the CG group (P = .037). The difference in notching severity between the groups was not statistically relevant; however, there was a trend toward more severe notching in the CG group (P = .059). Compared with a CG, an EG did not increase the percentage of radiolucent lines around the screws (3% vs. 1.5%, P = .62), around the post (3% vs. 1.5%, P = .62), or below the baseplate (15% vs. 7.5%, P = .18). CONCLUSION EGs are associated with less notching than CGs. This finding confirms that RSA with an EG is an effective procedure without specific complications at a minimum follow-up of 5 years.
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Affiliation(s)
- Philippe Collotte
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
| | | | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Peter Domos
- Royal Free London NHS Foundation Trust, London, UK
| | - Gilles Walch
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Lopiz Y, Galán-Olleros M, Rodriguez-Rodriguez L, García-Fernández C, Marco F. Radiographic changes around the glenoid component in primary reverse shoulder arthroplasty at mid-term follow-up. J Shoulder Elbow Surg 2021; 30:e378-e391. [PMID: 33197588 DOI: 10.1016/j.jse.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/20/2020] [Accepted: 10/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Some local events after reverse shoulder arthroplasty (RSA) occur without the patient experiencing symptoms and yet may be detected on diagnostic imaging, thereby serving as indicators of future complications that may require revision. Most of these events involve the glenoid component, but radiographic studies evaluating this component are scarce, especially medium- and long-term studies. This study aimed to analyze the radiographic changes around the glenoid component and determine the risk factors associated with the presence of these radiographic changes. MATERIALS AND METHODS A retrospective review of 105 primary Grammont-style RSAs implanted between 2003 and 2014 was conducted. Radiographic outcomes were evaluated in patients with ≥5 years of radiographic follow-up. Standardized digital radiographs obtained immediately postoperatively and at a minimum follow-up time of 5 years were analyzed to determine (1) glenoid component position (inclination and height) and (2) minor radiographic changes (Sirveaux grade 1 or 2 scapular notching; nondisplaced acromial fracture; radiolucent lines around 1 or 2 screws; Brooker grade 1a, 1b, or 2 heterotopic calcifications; or single screw rupture), as well as major radiographic changes (Sirveaux grade 3 or 4 scapular notching; radiolucent lines around ≥3 screws or central peg; Brooker grade 1c or 3 heterotopic calcifications; prosthetic dislocation; loosening or migration; or disassembly). RESULTS Major radiologic changes were identified in 14.3% of the cases. Bivariate analysis showed that more changes were associated with the arthroplasties implanted in the first years of the study (odds ratio [OR] = 0.81, P = .012). This time-related variable was also associated with inclination (OR = 0.88, P = .045) and height (OR = 0.75, P = .001), improving in arthroplasties implanted in the last years of the study. Multivariate analysis revealed an increased risk of severe scapular notching mainly associated with superior tilt (OR = 2.52, P = .036) and a high (OR = 2.68, P = .019) or excessively high (OR = 7.55, P = .013) position and an increased risk of loosening signs associated with superior tilt (OR = 8.92, P = 9.1 × 10-6). CONCLUSIONS The percentage of radiologic changes of the glenoid component in RSA is considerable, despite the detection of a decrease in their presence among the arthroplasties implanted outside the initial period. Superior tilt and an excessively high position appear to be associated with a severe degree of scapular notching development and increased risk of radiographic loosening signs. Knowledge of the factors associated with major radiologic changes in the medium-term follow-up will help to optimize the primary surgical technique for each patient and indication, improving implant survival in primary RSA surgery.
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Affiliation(s)
- Yaiza Lopiz
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain.
| | - María Galán-Olleros
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Luis Rodriguez-Rodriguez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, UGC de Reumatología, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos García-Fernández
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain; Department of Surgery, Complutense University, Madrid, Spain
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11
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Holschen M, Kiriazis A, Bockmann B, Schulte TL, Witt KA, Steinbeck J. Treating cuff tear arthropathy by reverse total shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical and the radiological outcome? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:307-315. [PMID: 33880654 DOI: 10.1007/s00590-021-02976-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Reverse total shoulder arthroplasty is widely used for the treatment of cuff tear arthropathy. Standard implants consist of a humeral component with an inclination angle of 155° and a glenosphere without lateral offset. Recently, lower inclination angles of the humeral component as well as lateralized glenospheres are implanted to provide better rotation of the arm and to decrease the rate of scapular notching. This study investigates the clinical and radiological results of a standard reverse total shoulder in comparison with an implant with an inclination angle of 135° in combination with a 4 mm lateralized glenosphere in context of cuff tear arthropathy. MATERIAL AND METHODS For this retrospective comparative analysis 42 patients treated by reverse total shoulder arthroplasty for cuff tear arthropathy were included. Twenty-one patients (m = 11, f = 10; mean age 76 years; mean follow-up 42 months) were treated with a standard 155° humeral component and a standard glenosphere with caudal eccentricity (group A), while twenty-one patients (m = 5, f = 16; mean age 72 years; mean follow-up 34 months) were treated with a 135° humeral component and 4 mm lateral offset of the glenosphere (group B). At follow-up patients of both groups were assessed with plain X-rays (a.p. and axial view), Constant Score, adjusted Constant Score, the subjective shoulder value and the range of motion. RESULTS The clinical results were similar in both groups concerning the Constant Score (group A = 56.3 vs. group B = 56.1; p = 0.733), the adjusted CS (group A = 70.4% vs. group B = 68.3%; p = 0.589) and the SSV (group A = 72.0% vs. group B = 75.2%; p = 0.947). The range of motion of the operated shoulders did not differ significantly between group A and group B: Abduction = 98° versus 97.9°, p = 0.655; external rotation with the arm at side = 17.9° versus 18.7°, p = 0.703; external rotation with the arm positioned in 90° of abduction = 22.3° versus 24.7°, p = 0.524; forward flexion = 116.1° versus 116.7°, p = 0.760. The rate of scapular notching was higher (p = 0.013) in group A (overall: 66%, grade 1: 29%, grade 2: 29%, grade 3: 10%, grade 4: 0%) in comparison to group B (overall: 33%, grade 1: 33%, grade 2: 0%, grade 3: 0%, grade 4: 0%). Radiolucency around the humeral component was detected in two patients of group B. Stress shielding at the proximal humerus was observed in six patients of Group A (29%; cortical thinning and osteopenia in zone M1 and L1) and two patients of group B (10%; cortical thinning and osteopenia in zone M1 and L1). Calcifications of the triceps origin were observed in both groups (group A = 48% vs. group B = 38%). CONCLUSION Theoretically, a lower inclination angle of the humeral component and an increased lateral offset of the glenosphere lead to improved impingement-free range of motion and a decreased rate of scapular notching, when compared to a standard reverse total shoulder implant. This study compared two different designs of numerous options concerning the humeral component and the glenosphere. In comparison to a standard-fashioned implant with a humeral inclination of 155° and a standard glenosphere, implants with a humeral inclination angle of 135° and a 4 mm lateralized glenosphere lead to comparable clinical results and rotatory function, while the rate of scapular notching is decreased by almost 50%. While the different implant designs did not affect the clinical outcome, our results indicate that a combination of a lower inclination angle of the humeral component and lateralized glenosphere should be favored to reduce scapular notching. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Malte Holschen
- Orthopedic Practice Clinic (OPPK), Schuerbusch 55, 48143, Münster, Germany. .,Raphaelsklinik, Münster, Germany.
| | | | - Benjamin Bockmann
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias L Schulte
- Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kai-Axel Witt
- Orthopedic Practice Clinic (OPPK), Schuerbusch 55, 48143, Münster, Germany
| | - Jörn Steinbeck
- Orthopedic Practice Clinic (OPPK), Schuerbusch 55, 48143, Münster, Germany
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12
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Boileau P, Morin-Salvo N, Bessière C, Chelli M, Gauci MO, Lemmex DB. Bony increased-offset-reverse shoulder arthroplasty: 5 to 10 years' follow-up. J Shoulder Elbow Surg 2020; 29:2111-2122. [PMID: 32505414 DOI: 10.1016/j.jse.2020.02.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid lateralization has been shown to be the most imortant factor in maximizing passive range of motion and shoulder stability while preventing scapular impingement and notching. We aimed to evaluate mid- to long-term functional and radiologic outcomes after bony increased-offset-reverse shoulder arthroplasty (BIO-RSA) using a Grammont-style (medialized) humeral implant. METHODS The study included 143 consecutive shoulders (140 patients; mean age, 72 years) treated with a BIO-RSA for rotator cuff deficiency. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate; fixation was achieved using a long central peg (25 mm) and 4 screws. A large baseplate (29 mm) with a small baseplate sphere (36 mm) was used in 77% of cases, and a Grammont-style (medialized) humeral implant with 155° of inclination was used in all cases. All patients underwent clinical and radiographic assessment at a minimum of 5 years after surgery; in addition, 86 cases (60%) underwent computed tomography scan assessment. RESULTS At a mean follow-up of 75 months (range, 60-126 months), the survivorship of the BIO-RSA using revision as an endpoint was 96%. No cases of dislocation or humeral loosening were observed. Overall, 118 patients (83%) were either very satisfied (61%) or satisfied (22%). The adjusted Constant score improved from 40% ± 18% to 93% ± 23%, and the Subjective Shoulder Value improved from 31% ± 15% to 77% ± 18% (P < .001). The humeral bone graft incorporated completely in 96% of cases (137 of 143). Severe inferior scapular notching (grade 3 or 4) occurred in 18% (24 of 136). The risk of postoperative notching correlated to a lower body mass index (P < .05), superior glenosphere inclination (P = .02), and high or flush glenosphere positioning (P = .035). CONCLUSIONS BIO-RSA is a safe and effective technique to lateralize the glenoid, providing consistent bone graft healing, excellent functional outcomes, a low revision rate, and a high rate of patient satisfaction. Thin patients (with a low body mass index) and glenosphere malposition (with persistent superior inclination and/or insufficient lowering of the baseplate and sphere) are associated with higher risk of scapular notching.Our data confirm the importance of implanting the baseplate with a neutral inclination (reverse shoulder arthroplasty angle < 5°) and with sufficient glenosphere inferior overhang (>5 mm) in preventing scapular notching. The use of a less medialized humeral implant (135° or 145° inclined) and smaller (25-mm) baseplate (when using a small, 36-mm sphere) should allow reduction in the incidence of scapular notching.
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Affiliation(s)
- Pascal Boileau
- IULS-University Institute for Locomotion and Sports, Hôpital Pasteur 2, University Côte d'Azur (UCA), Nice, France.
| | | | | | - Mikaël Chelli
- IULS-University Institute for Locomotion and Sports, Hôpital Pasteur 2, University Côte d'Azur (UCA), Nice, France
| | - Marc-Olivier Gauci
- IULS-University Institute for Locomotion and Sports, Hôpital Pasteur 2, University Côte d'Azur (UCA), Nice, France
| | - Devin B Lemmex
- PanAm Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
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Shah SS, Gaal BT, Roche AM, Namdari S, Grawe BM, Lawler M, Dalton S, King JJ, Helmkamp J, Garrigues GE, Wright TW, Schoch BS, Flik K, Otto RJ, Jones R, Jawa A, McCann P, Abboud J, Horneff G, Ross G, Friedman R, Ricchetti ET, Boardman D, Tashjian RZ, Gulotta LV. The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part I. JSES Int 2020; 4:929-943. [PMID: 33345237 PMCID: PMC7738599 DOI: 10.1016/j.jseint.2020.07.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this 2-part study was to systematically review each of the most common complications of RSA, limiting each search to publications in 2010 or later. In this part (part I), we examined (1) scapular notching (SN), (2) periprosthetic infection (PJI), (3) mechanical failure (glenoid or humeral component), and (4) neurologic injury (NI). Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Overall, 113 studies on SN, 62 on PJI, 34 on mechanical failure, and 48 on NI were included in our reviews. Univariate analysis was performed with the χ2 or Fisher exact test. Results The Grammont design had a higher SN rate vs. all other designs combined (42.5% vs. 12.3%, P < .001). The onlay humeral design had a lower rate than the lateralized glenoid design (10.5% vs. 14.8%, P < .001). The PJI rate was 2.4% for primary RSA and 2.6% for revision RSA. The incidence of glenoid and humeral component loosening was 2.3% and 1.4%, respectively. The Grammont design had an increased NI rate vs. all other designs combined (0.9% vs. 0.1%, P = .04). Conclusions Focused systematic reviews of the recent literature with a large volume of RSAs demonstrate that with the use of non-Grammont modern prosthesis designs, complications including SN, PJI, glenoid component loosening, and NI are significantly reduced compared with previous studies. As the indications for RSA continue to expand, it is imperative to accurately track the rates and types of complications to justify its cost and increased indications.
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Affiliation(s)
- Sarav S Shah
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Benjamin T Gaal
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Alexander M Roche
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Surena Namdari
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Brian M Grawe
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Macy Lawler
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Stewart Dalton
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joseph J King
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joshua Helmkamp
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Grant E Garrigues
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Thomas W Wright
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Bradley S Schoch
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Kyle Flik
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Randall J Otto
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Richard Jones
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Andrew Jawa
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Peter McCann
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Joseph Abboud
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Gabe Horneff
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Glen Ross
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Richard Friedman
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Eric T Ricchetti
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Douglas Boardman
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Robert Z Tashjian
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
| | - Lawrence V Gulotta
- American Shoulder and Elbow Surgeons Multicenter Task Force on Reverse Total Shoulder Arthroplasty Complications, Rosemont, IL, USA
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14
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Collotte P, Erickson J, Vieira TD, Domos P, Walch G. Midterm clinical and radiologic results of reverse shoulder arthroplasty with an eccentric glenosphere. J Shoulder Elbow Surg 2020; 29:976-981. [PMID: 31911214 DOI: 10.1016/j.jse.2019.09.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND An eccentric glenosphere (EG) has been proposed as a way of preventing scapular notching after reverse shoulder arthroplasty (RSA). Our aim was to report the midterm clinical and radiographic results of EG after RSA. A number of the patients described here were included in a previous study with short-term follow-up. The current retrospective study gave us the opportunity to follow many of these patients for a longer period of time. METHODS A retrospective analysis of prospectively collected data was conducted. Statistical significance was set at P < .001. Forty-nine RSAs with an EG and at least 60 months of follow-up were included. Range of motion (ROM), Constant scores (CSs), and Subjective Shoulder Value (SSV) were assessed. Scapular notching was graded according to the Sirveaux classification. RESULTS At the last follow-up, the mean improvement in active elevation (ROM) was 46° and the mean CS increased by nearly 31 points (both groups P < .001). The final SSV was 70%. Twenty-one patients (43%) had scapular notching, but in two-thirds of patients it was low-grade. CONCLUSION The use of an EG provided excellent clinical outcomes that persisted with midterm follow-up. The rate of notching was lower than in other studies with EGs, but further studies are required to confirm this. An EG was safe and there were no issues with baseplate loosening or failure.
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Affiliation(s)
- Philippe Collotte
- Ramsay Générale de Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.
| | | | - Thais Dutra Vieira
- Ramsay Générale de Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Peter Domos
- The Royal Free London NHS Foundation Trust, London, UK
| | - Gilles Walch
- Ramsay Générale de Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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15
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Lädermann A, Denard PJ, Collin P, Zbinden O, Chiu JCH, Boileau P, Olivier F, Walch G. Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty. INTERNATIONAL ORTHOPAEDICS 2020; 44:519-530. [PMID: 31900574 DOI: 10.1007/s00264-019-04463-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/06/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine how different combinations of humeral stem and glenosphere designs for reverse shoulder arthroplasty (RSA) influence range of motion (ROM) and muscle elongation. METHODS A computed tomography scan of a non-pathologic shoulder was used to simulate all shoulder motions, and thereby compare the ROM and rotator cuff muscle lengths of the native shoulder versus 30 combinations of humeral components (1 inlay straight stem with 155° inclination and five onlay curved stems with 135°, 145° or 155° inclinations, using concentric, medialized or lateralized trays) and glenospheres (standard, large, lateralized, inferior eccentric and bony increased-offset (BIO-RSA)). RESULTS Only five of the 30 combinations restored ≥ 50% of the native ROM in all directions: the 145° onlay stem (concentric tray) combined with lateralized or inferior eccentric glenospheres and the 145° stem (lateralized tray) combined with either a large, lateralized or inferior eccentric glenosphere. Lengthening of the supraspinatus and infraspinatus, observed for all configurations, was greatest using onlay stems (7-30%) and BIO-RSA glenospheres (13-31%). Subscapularis lengthening was observed for onlay stems combined with BIO-RSA glenospheres (5-9%), while excessive subscapularis shortening was observed for the inlay stem combined with all glenospheres except the BIO-RSA design (> 15%). CONCLUSIONS The authors suggest implanting 145° onlay stems, with concentric or lateralized trays, together with lateralized or inferior eccentric glenospheres.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France
| | - Olivia Zbinden
- Service of Orthopedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Joe Chih-Hao Chiu
- Department of Orthopaedic Sports Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Pascal Boileau
- iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d'Azur, Nice, France
| | - Flora Olivier
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Gilles Walch
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France
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Torrens C, Miquel J, Martínez R, Santana F. Can small glenospheres with eccentricity reduce scapular notching as effectively as large glenospheres without eccentricity? A prospective randomized study. J Shoulder Elbow Surg 2020; 29:217-224. [PMID: 31784386 DOI: 10.1016/j.jse.2019.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to analyze whether small glenospheres with eccentricity were comparable to large glenospheres in scapular notch development. METHODS This prospective randomized study included 82 patients who had undergone a reverse shoulder arthroplasty with a 2-year follow-up period. After randomization, 43 patients were allocated to receive a 42-mm glenosphere and 39 patients were allocated to receive a 38-mm glenosphere with 2 mm of eccentricity. Scapular notch development was defined after examination of an anteroposterior radiograph at the end of follow-up. Functional outcomes were recorded using the Constant score before surgery and at the end of follow-up. RESULTS Scapular notch development was present in 16.6% of patients who received a 42-mm glenosphere and 34.2% of patients who received a 38-mm eccentric glenosphere. No significant difference was found between the groups with the number of cases available (P = .07). Functional outcomes significantly increased from preoperatively to postoperatively in both groups, with no significant difference found between them (P = .77). The mean glenosphere overhang measure was 6.3 mm in patients with a 42-mm glenosphere and 6.0 mm in those with a 38-mm eccentric glenosphere (P = .68). No significant differences were noted between patients with a scapular notch and patients without a scapular notch in terms of functional outcomes. DISCUSSION Small glenospheres with eccentricity fared slightly worse than large glenospheres regarding scapular notch development, even though no significant differences were noted. Functional outcomes were comparable between the 2 designs.
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Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
| | - Joan Miquel
- Department of Orthopedics, Hospital d'Igualada, Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - Raquel Martínez
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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Kazley JM, Cole KP, Desai KJ, Zonshayn S, Morse AS, Banerjee S. Prostheses for reverse total shoulder arthroplasty. Expert Rev Med Devices 2019; 16:107-118. [DOI: 10.1080/17434440.2019.1568237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | - Keegan P. Cole
- Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
| | | | | | | | - Samik Banerjee
- Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
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18
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Dharia MA, Bischoff JE, Schneider D. Impact of Modeling Assumptions on Stability Predictions in Reverse Total Shoulder Arthroplasty. Front Physiol 2018; 9:1116. [PMID: 30246784 PMCID: PMC6110894 DOI: 10.3389/fphys.2018.01116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/25/2018] [Indexed: 11/23/2022] Open
Abstract
Reverse total shoulder arthroplasty (rTSA) is commonly used in the shoulder replacement surgeries for the relief of pain and to restore function, in patients with grossly deficient rotator cuff. Primary instability due to glenoid loosening is one of the critical complications of rTSA; the implants are designed and implanted such that the motion between the glenoid baseplate and underlying bone is minimized to facilitate adequate primary fixation. Finite element analysis (FEA) is commonly used to simulate the test setup per ASTM F2028-14 for comparing micromotion between designs or configurations to study the pre-clinical indications for stability. The FEA results can be influenced by the underlying modeling assumptions. It is a common practice to simplify the screw shafts by modeling them as cylinders and modeling the screw-bone interface using bonded contact, to evaluate micromotion in rTSA components. The goal of this study was to evaluate the effect of three different assumptions for modeling the screw-bone interface on micromotion predictions. The credibility of these modeling assumptions was examined by comparing the micromotion rank order predicted among three different modular configurations with similar information from the literature. Eight configurations were modeled using different number of screws, glenosphere offset, and baseplate sizes. An axial compression and shear load was applied through the glenosphere and micromotion at the baseplate-bone interface was measured. Three modeling assumptions pertaining to modeling of the screw-bone interface were used and micromotion results were compared to study the effect of number of peripheral screws, eccentricities, and baseplate diameter. The relative comparison of micromotion between configurations using two versus four peripheral screws remained unchanged irrespective of the three modeling assumptions. However, the relative comparison between two inferior offsets and baseplate sizes changed depending on the modeling assumptions used for the screw-bone interface. The finding from this study challenges the generally believed hypothesis that FEA models can be used to make relative comparison of micromotion in rTSA designs as long as the same modeling assumptions are used across all models. The comparisons with previously published work matched the finding from this study in some cases, whereas the comparison was contradicting in other cases. It is essential to validate the computer modeling approach with an experiment using similar designs and methods to increase the confidence in the predictions to make design decisions.
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Affiliation(s)
- Mehul A Dharia
- Computational Biomechanics, Corporate Research, Zimmer Biomet, Warsaw, IN, United States
| | - Jeffrey E Bischoff
- Computational Biomechanics, Corporate Research, Zimmer Biomet, Warsaw, IN, United States
| | - David Schneider
- Shoulder & Elbow Institute, Panorama Orthopedics & Spine Center, Golden, CO, United States
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Towards standardised definitions of shoulder arthroplasty complications: a systematic review of terms and definitions. Arch Orthop Trauma Surg 2017; 137:347-355. [PMID: 28168641 DOI: 10.1007/s00402-017-2635-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION A transparent, reliable and accurate reporting of complications is essential for an evidence-based evaluation of shoulder arthroplasty (SA). We systematically reviewed the literature for terms and definitions related to negative events associated with SA. MATERIALS AND METHODS Various biomedical databases were searched for reviews, clinical studies and case reports of complications associated with SA. Any general definition of a complication, classification system, all reported terms related to complications and negative events with their definitions were extracted. Terms were grouped and organised in a hierarchical structure. Definitions of negative events were tabulated and compared. RESULTS From 1086 initial references published between 2010 and 2014, 495 full-text papers were reviewed. Five reports provided a general definition of the term "surgical complication" and 29 used a classification system of complications. A total of 1399 extracted terms were grouped based on similarities and involved implant or anatomical parts. One hundred and six reports (21.4%) defined at least one negative event for 28 different terms. There were 64 definitions related to humeral or glenoid loosening, and 25 systems documenting periprosthetic radiolucency. Other definitions considered notching, stress shielding, implant failure and tuberosity malposition. CONCLUSIONS A clear standardised set of SA complication definitions is lacking. Few authors reported complications based on definitions mainly considering radiological criteria without clinical parameters. This review should initiate and support the development of a standardised SA complication core set.
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Affiliation(s)
- Kamal I Bohsali
- 1Jacksonville Orthopaedic Institute, Jacksonville Beach, Florida 2Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 3Department of Orthopaedics, University of Texas HSC-San Antonio, San Antonio, Texas
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Torrens C, Guirro P, Miquel J, Santana F. Influence of glenosphere size on the development of scapular notching: a prospective randomized study. J Shoulder Elbow Surg 2016; 25:1735-1741. [PMID: 27742246 DOI: 10.1016/j.jse.2016.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/09/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The objective of the study was to evaluate the development of scapular notching in reverse shoulder arthroplasty by comparing larger glenospheres (42 mm) with smaller glenospheres (38 mm). METHODS This was a prospective randomized study of 81 patients who had undergone reverse shoulder arthroplasty with a 2-year follow-up. Patients were randomized to receive either a 42-mm glenosphere (38 patients) or a 38-mm glenosphere (43 patients). Scapular notching development was assessed with an anteroposterior radiograph at the end of the follow-up. Functional outcome was assessed with the Constant score before surgery and at the end of follow-up. An independent blinded observer carried out radiologic and clinical assessments. RESULTS Scapular notching was present in 48.8% of the patients receiving a 38-mm glenosphere and in 12.1% of the patients receiving one of 42 mm, with significant differences between both (P < .001). No significant differences were noted between the 2 glenosphere size groups in terms of the total Constant score. Patients with a 42-mm glenosphere had a mean glenoid-glenosphere overhang of 6.1 mm, whereas patients with a 38-mm glenosphere had one of 4.2 mm, with significant differences between them (P < .001). No significant differences in the total Constant score were found between the patients whether they had scapular notching or not. CONCLUSION Bigger glenospheres (42 mm) significantly reduce development of scapular notching compared with smaller glenospheres (38 mm). Glenosphere size has no significant influence on functional outcomes measured with the Constant score.
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Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
| | - Pau Guirro
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Joan Miquel
- Department of Orthopedics, Hospital d'Igualada, Consorci Sanitari de l'Anoia, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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The effect of glenosphere size on functional outcome for reverse shoulder arthroplasty. Musculoskelet Surg 2016; 100:115-20. [PMID: 26861683 DOI: 10.1007/s12306-015-0396-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/19/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Reverse shoulder arthroplasty (RSA) is an effective surgery for a variety of patients with difficult shoulder pathology. Since postsurgical outcomes are often variable, there has been great effort made to optimize the design and use of these implants. Previous studies demonstrated an association between increased glenosphere size and improved range of motion. The purpose of this study is to assess the relationship between glenosphere size, range of motion, and functional outcome scores. METHODS This is a retrospective cohort study of 140 patients (148 shoulders) undergoing reverse shoulder arthroplasty. All patients were assessed pre- and postoperatively for range of motion, Constant score, ASES score, and Subjective Shoulder Value. Improvements in these variables were compared for patients treated with three different glenosphere sizes (36, 40, 42 mm). RESULTS All groups had a mean improvement in range of motion and functional outcome scores, but there were no statistically significant differences between groups when controlling for preoperative differences. CONCLUSIONS Our findings do not support a strong role for glenosphere size as a singular factor affecting range of motion or patient-reported outcome following RSA. These problems are most likely due to the multifactorial nature of shoulder dynamics. For this reason, assessing the effect a single surgical or biomechanical parameter on function has been challenging.
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Outcomes of reverse shoulder arthroplasty using a mini 25-mm glenoid baseplate. INTERNATIONAL ORTHOPAEDICS 2015; 40:109-13. [PMID: 26231495 DOI: 10.1007/s00264-015-2945-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/19/2015] [Indexed: 10/23/2022]
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Postacchini R, Carbone S, Canero G, Ripani M, Postacchini F. Reverse shoulder prosthesis in patients with rheumatoid arthritis: a systematic review. INTERNATIONAL ORTHOPAEDICS 2015. [DOI: 10.1007/s00264-015-2916-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Postacchini R, Paoloni M, Carbone S, Fini M, Santilli V, Postacchini F, Mangone M. Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty. J Biomech 2015. [PMID: 26194874 DOI: 10.1016/j.jbiomech.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.
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Affiliation(s)
- Roberto Postacchini
- Department of Orthopedic Surgery, Israelitic Hospital, Italian University Sport and Movement, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.
| | - Stefano Carbone
- Department of Orthopedic Surgery, Sapienza University, Rome, Italy
| | | | - Valter Santilli
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy
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Li X, Dines JS, Warren RF, Craig EV, Dines DM. Inferior glenosphere placement reduces scapular notching in reverse total shoulder arthroplasty. Orthopedics 2015; 38:e88-93. [PMID: 25665124 DOI: 10.3928/01477447-20150204-54] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 04/28/2014] [Indexed: 02/03/2023]
Abstract
Scapular notching is a common complication after reverse shoulder arthroplasty and has been associated with poor clinical outcomes. Factors associated with notching include neck shaft angle and glenosphere position. The goal of this study was to evaluate the incidence of notching with an eccentric glenosphere that allows for inferior offset as well as its effect on clinical outcome. The charts of 82 patients who underwent reverse shoulder arthroplasty with this eccentric glenosphere were retrospectively reviewed. Scapular notching was assessed with standard anteroposterior radiographs of the glenohumeral joint according to the Nerot-Sirveaux classification system. Two experienced observers evaluated all radiographs. The presence of radiolucent lines was also evaluated. Both range of motion (ROM) and Constant-Murley scores were obtained. Average age was 74 years (range, 61-91 years), and follow-up was 26.3 months (range, 19-39 months). According to the Nerot-Sirveaux classification, 73 (89%) had no notching, 5 (6%) had grade I notching, 2 (2.5%) had grade II notching, and 2 (2.5%) had grade III notching. The overall presence of notching was 11% and correlated to the amount of inferior offset. No radiolucent lines were seen around the prosthesis. Both ROM and Constant-Murley scores (from 31.3 to 74.2) improved significantly in all patients from preoperative evaluation to final follow-up (P<.05). No significant differences in ROM and functional outcome were seen between the groups with and without notching. The inferior offset glenosphere created with this glenosphere base plate design reduced the incidence of scapular notching in reverse shoulder arthroplasty. This was particularly true when the glenosphere was maximally offset inferiorly. In the short term, notching does not affect ROM or functional outcome.
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Lee LH, Desai A. Reverse polarity shoulder replacement: Current concepts and review of literature. World J Orthop 2014; 5:255-61. [PMID: 25035828 PMCID: PMC4095018 DOI: 10.5312/wjo.v5.i3.255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 04/08/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
Shoulder replacement in cuff tear arthropathy (CTA) is an unsolved challenge. CTA poses a soft tissue deficiency in an arthritic glenohumeral joint which the anatomical total shoulder replacement and hemiarthroplasty cannot reliably provide stability, range of movement, function or satisfactory long term outcome. In the past two decades since the introduction of the reverse shoulder replacement, the prosthesis has evolved and has shown promising results. It is a partially constraint joint by virtue of its design features. The reversal of the concavity and convexity of the joint to the proximal humerus and the glenoid, respectively, also shifts and improves its center of rotation onto the osseous surface of the glenoid with less exposure to shear stress. It is a successful pain relieving procedure, offering good outcome in patients with irreparable massive rotator cuff tear with or without osteoarthritis. Consequently, this has led to wider use and expansion of its indication to include more complex elective and trauma cases. Whereas originally used in the more elderly patients, there is increasingly more demand in the younger patients. It is important to have good quality long term data to support these increasing indications. Therefore, we review the literature on the concepts of reverse shoulder replacement and the contemporary evidence.
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Kadum B, Mukka S, Englund E, Sayed-Noor A, Sjödén G. Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study. INTERNATIONAL ORTHOPAEDICS 2014; 38:1001-6. [PMID: 24458592 DOI: 10.1007/s00264-013-2277-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 12/29/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. METHODS This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. RESULTS We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome. CONCLUSIONS Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.
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Affiliation(s)
- Bakir Kadum
- Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden,
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Arm lengthening after reverse shoulder arthroplasty: a review. INTERNATIONAL ORTHOPAEDICS 2013; 38:991-1000. [PMID: 24271331 DOI: 10.1007/s00264-013-2175-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/28/2013] [Indexed: 01/30/2023]
Abstract
PURPOSE The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications. METHODS Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I-IV relevant to search terms. RESULTS Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15 mm to 27 mm. The acromiohumeral distance averaged 23 mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent. CONCLUSIONS Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment.
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