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Wiater JM, Lee JYJ, Shields EJW, Childers K, Dery L, Koueiter D. Humeral Component Version Has No Effect on Outcomes Following Reverse Total Shoulder Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial. J Bone Joint Surg Am 2024; 106:1181-1188. [PMID: 38758820 DOI: 10.2106/jbjs.23.00893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Controversy exists regarding the ideal humeral component version to optimize humeral rotation and patient outcomes in reverse total shoulder arthroplasty (rTSA). METHODS Patients undergoing primary rTSA for rotator cuff tear arthropathy, a massive rotator cuff tear, or primary osteoarthritis with a rotator cuff tear were randomized to placement of the humeral component in neutral version or 30° of retroversion. Shoulder active range of motion and strength and visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES), and Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) scores were collected up to 2 years postoperatively. The goal of the study was to determine whether humeral external rotation and internal rotation are affected by humeral component version following rTSA at 2 years postoperatively. RESULTS Sixty-six patients were included in the analysis. The median follow-up was 26 months for the neutral and 27 months for the 30° retroversion group. No differences between the groups were observed with respect to the primary diagnosis, sex, age, body mass index, or American Society of Anesthesiologists (ASA) class. The 2 groups did not differ significantly in terms of improvement at 2 years in active shoulder abduction (p = 0.969), forward elevation (p = 1.000), internal rotation measured as the highest spinal level reached (p = 1.000), internal rotation with the arm abducted 90° (p = 0.451), external rotation (p = 0.362), or muscle strength in forward elevation (p = 1.000), abduction (p = 1.000), external rotation (p = 0.617), or internal rotation (p = 1.000). The 2 groups did not differ significantly in terms of improvement in postoperative ASES (p = 1.000), PROMIS-10 physical (p = 1.000), or VAS pain scores (p = 0.718) at the time of final follow-up. In the neutral version group, 1 patient underwent revision for instability and 1 for stiffness. One acromial stress fracture occurred in the 30° humeral retroversion group. Scapular notching was observed in 7 (21.2%) of the patients in neutral version group and 5 (15.2%) of the patients in the 30° retroversion group (p = 0.750). CONCLUSIONS Securing the humeral component at neutral version or 30° of retroversion in rTSA resulted in similar active shoulder external rotation, internal rotation, forward elevation, abduction, and strength measurements, complication rates, and VAS pain, PROMIS-10 physical, and ASES scores at 2 years postoperatively. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- J Michael Wiater
- Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - James Y J Lee
- Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | | | - Karen Childers
- Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Lauren Dery
- Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Denise Koueiter
- Department of Orthopaedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
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Jomaa MN, Branni M, Ingoe H, Pareyon R, Italia K, Launay M, Salhi A, Gilliand L, Nielsen J, Maharaj J, Cutbush K, Gupta A. Does forearm referencing using a retroversion guide achieve the targeted retroversion of the humeral component in reverse shoulder arthroplasty? J Shoulder Elbow Surg 2024; 33:1555-1562. [PMID: 38122891 DOI: 10.1016/j.jse.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Component positioning affects clinical outcomes of reverse shoulder arthroplasty, which necessitates an implantation technique that is reproducible, consistent, and reliable. This study aims to assess the accuracy and precision of positioning the humeral component in planned retroversion using a forearm referencing guide. METHODS Computed tomography scans of 54 patients (27 males and 27 females) who underwent primary reverse shoulder arthroplasty for osteoarthritis or cuff tear arthropathy were evaluated. A standardized surgical technique was used to place the humeral stem in 15° of retroversion. Version was assessed intraoperatively visualizing the retroversion guide from above and referencing the forearm axis. Metal subtraction techniques from postoperative computed tomography images allowed for the generation of 3D models of the humerus and for evaluation of the humeral component position. Anatomical humeral plane and implant planes were defined and the retroversion 3D angle between identified planes was recorded for each patient. Accuracy and precision were assessed. A subgroup analysis evaluated differences between male and female patients. RESULTS The humeral retroversion angle ranged from 0.9° to 22.8°. The majority (81%) of the measurements were less than 15°. Mean retroversion angle (±SD) was 9.9° ± 5.8° (95% CI 8.4°-11.5°) with a mean percent error with respect to 15° of -34% ± 38 (95% CI -23 to -44). In the male subgroup (n = 27, range 3.8°-22.5°), the mean retroversion angle was 11.9° ± 5.4° (95% CI 9.8°-14.1°) with a mean percent error with respect to 15° of -21% ± 36 (95% CI -6 to -35). In the female subgroup (n = 27, range 0.9°-22.8°), mean retroversion angle was 8.0° ± 5.5° (95% CI 5.8°-10.1°) and the mean percent error with respect to 15° was -47% ± 36 (95% CI -32 to -61). The differences between the 2 gender groups were statistically significant (P = .006). CONCLUSION Referencing the forearm using an extramedullary forearm referencing system to position the humeral stem in a desired retroversion is neither accurate nor precise. There is a nonnegligible tendency to achieve a lower retroversion than planned, and the error is more marked in females.
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Affiliation(s)
- Mohammad N Jomaa
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia.
| | - Marco Branni
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Helen Ingoe
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Roberto Pareyon
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Marine Launay
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Asma Salhi
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Luke Gilliand
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - James Nielsen
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Jashint Maharaj
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
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Andrews R, Layuno-Matos JG, Frankle MA. Common Factors in Shoulder and Hip Arthroplasty Implant Failures: A Historical Review. J Clin Med 2024; 13:2370. [PMID: 38673642 PMCID: PMC11051213 DOI: 10.3390/jcm13082370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
In this era of subspecialty care in orthopedics, iterations of implant design can occur in a silo which then precludes gaining knowledge from failures of implant design that may have occurred in different subspecialties. This literature review describes the history of failures in hip and shoulder arthroplasties with the purpose of identifying similar factors that led to previous implant failures. A review of the literature was performed by two reviewers assessing articles that described failed hip and shoulder arthroplasty systems over time. We identified and analyzed 53 implant failures-23 in hip arthroplasty and 30 in shoulder arthroplasty. These failures were categorized as material, mechanical, and technical. In hip arthroplasty, 48% were material, 39% mechanical, and 13% technical failures. In shoulder arthroplasty, the distribution was 10% material, 70% mechanical, and 20% technical failures. The distribution of these failures highlights similar and sometimes repeated failure mechanisms between subspecialties. This accentuates the importance of a collaborative approach to improve future arthroplasty designs.
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Affiliation(s)
- Reed Andrews
- Department of Orthopaedics, School of Medicine, University of South Florida, Tampa, FL 33612, USA;
| | | | - Mark A. Frankle
- Foundation for Orthopaedic Research and Education, Tampa, FL 33607, USA;
- Florida Orthopaedic Institute, Tampa, FL 33637, USA
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Schroeder DD, Borsgard A, Rossman TL, Stewart CM. Modification of Humeral Component Results in Increased Impingement Free Range of Motion in a Reverse Shoulder Arthroplasty Model. J Shoulder Elb Arthroplast 2024; 8:24715492241237034. [PMID: 38628981 PMCID: PMC11020712 DOI: 10.1177/24715492241237034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/11/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Shoulder arthroplasties have been demonstrated to provide reliable pain relief as well as functional benefits. The advent of the reverse shoulder arthroplasty allowed for expanded indications for shoulder replacement. Several studies comparing the outcomes of anatomic and reverse total shoulder arthroplasties have demonstrated decreased range of motion in the reverse arthroplasty cohort, especially in internal rotation. The authors hypothesized that slight modifications to the humeral component of a reverse shoulder arthroplasty could result in increased impingement free range of motion without significant sacrifices to stability. Methods A reverse shoulder arthroplasty model was fashioned to mimic a setting of anterior mechanical impingement after replacement. Sequential resections were taken from the anterior aspect of the polyethylene up to a resection of 10 mm. A solid modeling software was utilized to compare the experimental group to the control group with regard to impingement free motion. Finite element analysis was subsequently utilized to assess stability of the construct in comparison to the nonmodified polyethylene. Results Impingement free internal rotation increased minimally at 3 mm of resection but considerably at each further increase in resection. A resection of 10 mm resulted roughly 30% improvement in impingement free internal rotation. Instability in this model increased with modifications beyond 7 mm. Conclusion Slight alterations to the geometry of the humeral tray and polyethene components can result in improvements in impingement-free internal rotation without substantial increased instability in this model. Further work is needed to determine in vivo implications of modifications to the humeral tray and polyethylene.
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Jin H, Jiang S, Pavel V, Tadum Arthur Vithran D, Xiao W, Li Y. Global trends and research hotspots of reverse total shoulder arthroplasty: a bibliometric analysis from 1991 to 2022. EFORT Open Rev 2024; 9:297-308. [PMID: 38579787 PMCID: PMC11044086 DOI: 10.1530/eor-23-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Reverse total shoulder arthroplasty (rTSA) has been demonstrated to be an effective intervention for various shoulder disorders. The number of rTSA-related studies performed has increased annually over the past three decades. The Journal of Shoulder and Elbow Surgery had the highest number of publications and citations in the rTSA-related research domain and is therefore considered to be the most influential journal in this field. The USA published the most publications and established a high degree of cooperation with many countries worldwide. The University of Florida, the Hospital for Special Surgery, and Rush University, Mayo Clinic were representative and active institutions in this field. It is anticipated that advancements in prosthesis design, specifically with regards to lateralized design concepts, expanding indications for rTSA, a trend toward younger patient populations, and the management of postoperative complications will emerge as research hotspots in the following years. The most valuable publications, influential journals, major researchers, and leading countries were analyzed. The findings of our study will help researchers gain insights into current research hotspots and frontiers and shape their research focus in the field of rTSA.
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Affiliation(s)
- Hongfu Jin
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shide Jiang
- Department of Orthopaedics, The Central Hospital of Yongzhou, Yongzhou, Hunan, China
| | - Volotovski Pavel
- Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Belarus
| | - Djandan Tadum Arthur Vithran
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Shafritz A, Mangan J, DeSarno M, Kanner CD. Mid-term results of the use of structural humeral head autograft to correct glenoid bone loss in reverse total shoulder arthroplasty. JSES Int 2024; 8:132-140. [PMID: 38312272 PMCID: PMC10837731 DOI: 10.1016/j.jseint.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Native glenoid bone loss presents technical challenges in shoulder arthroplasty. The purpose of this study is to report the mid-term clinical and radiographic outcomes of patients treated with structural humeral head autograft reconstruction of glenoid bone loss in the setting of reverse total shoulder arthroplasty (rTSA). Methods Retrospective review of 30 shoulders in 28 patients undergoing rTSA with a structural humeral head autograft to correct glenoid bone loss. Demographics, comorbidities, anatomic details, and patient-reported outcome measures were collected for analysis. Results Range of motion and patient-reported outcome measures were all significantly improved postoperatively (P < .001). Bone grafts were found to incorporate into 100% of shoulders, with no protheses displaying signs of loosening or other structural concerns. No revision procedures were performed, and all patients were satisfied with their shoulder postoperatively. Two patients developed scapular notching on follow-up. Discussion The use of a humeral head autograft to reconstruct glenoid bone loss in patients undergoing rTSA is a safe and effective procedure. It allows for a local graft source to be utilized thus avoiding potential comorbidity and complications associated with the use of alternative site autografts or allografts and has the advantage of nearly congruent fit within the defect.
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Affiliation(s)
- Adam Shafritz
- Department of Orthopedic Surgery, University of Vermont Medical Center, Burlington, VT, USA
| | - Jack Mangan
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Michael DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Christopher D Kanner
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
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Zhou Y, Mandaleson A, Frampton C, Hirner M. Medium-term results of inlay vs. onlay humeral components for reverse shoulder arthroplasty: a New Zealand Joint Registry study. J Shoulder Elbow Surg 2024; 33:99-107. [PMID: 37423461 DOI: 10.1016/j.jse.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The purpose of this study was to compare medium-term results of inlay and onlay humeral components in reverse shoulder arthroplasty (RSA). Specifically, we report differences in revision rate and functional outcomes between the 2 designs. METHODS The 3 most used inlay (in-RSA) and onlay (on-RSA) implants by volume from the New Zealand Joint Registry were included in the study. In-RSA was defined as having a humeral tray that recessed within the metaphyseal bone, whereas on-RSA was defined as having a humeral tray that rested on the epiphyseal osteotomy surface. The primary outcome was revision up to 8 years postsurgery. Secondary outcomes included the Oxford Shoulder Score (OSS), implant survival, and revision cause for in-RSA and on-RSA as well as individual prostheses. RESULTS There were 6707 patients (5736 in-RSA; 971 on-RSA) included in the study. For all causes, in-RSA demonstrated a lower revision rate compared to on-RSA (revision rate/100 component years: in-RSA 0.665, 95% confidence interval [CI] 0.569-0.768; on-RSA 1.010, 95% CI 0.673-1.415). However, the mean 6-month OSS was higher for the on-RSA group (mean difference 2.20, 95% CI 1.37-3.03; P < .001). However, this was not clinically significant. At 5 years, there were no statistically or clinically significant differences between the 2 groups with respect to the OSS. CONCLUSION The medium-term survival of in-RSA was higher than that of on-RSA. However, functional outcomes at 6 months were better for on-RSA compared to in-RSA. Further follow-up is required to understand the long-term survivorship and functional outcomes between these designs.
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Affiliation(s)
- Yushy Zhou
- Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand; Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, St. Vincent's Hospital, Melbourne, VIC, Australia.
| | - Avanthi Mandaleson
- Department of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, VIC, Australia
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marc Hirner
- Department of Orthopaedic Surgery, Whangarei Hospital, Whangarei, New Zealand
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Förstl N, Süß F, Englert C, Dendorfer S. Design of a reverse shoulder implant to measure shoulder stiffness during implant component positioning. Med Eng Phys 2023; 121:104059. [PMID: 37985021 DOI: 10.1016/j.medengphy.2023.104059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023]
Abstract
To avoid dislocation of the shoulder joint after reverse total shoulder arthroplasty, it is important to achieve sufficient shoulder stability when placing the implant components during surgery. One parameter for assessing shoulder stability can be shoulder stiffness. The aim of this research was to develop a temporary reverse shoulder implant prototype that would allow intraoperative measurement of shoulder stiffness while varying the position of the implant components. Joint angle and torque measurement techniques were developed to determine shoulder stiffness. Hall sensors were used to measure the joint angles by converting the magnetic flux densities into angles. The accuracy of the joint angle measurements was tested using a test bench. Torques were determined by using thin-film pressure sensors. Various mechanical mechanisms for variable positioning of the implant components were integrated into the prototype. The results of the joint angle measurements showed measurement errors of less than 5° in a deflection range of ±15° adduction/abduction combined with ±45° flexion/extension. The proposed design provides a first approach for intra-operative assessment of shoulder stiffness. The findings can be used as a technological basis for further developments.
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Affiliation(s)
- Nikolas Förstl
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Galgenbergstraße 30, 93053 Regensburg, Germany.
| | - Franz Süß
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Galgenbergstraße 30, 93053 Regensburg, Germany; Regensburg Center for Biomedical Engineering, RCBE. University and Ostbayerische Technische Hochschule Regensburg, Germany
| | - Carsten Englert
- Orthopaedics and trauma surgery, Hospital zum Heiligen Geist Fritzlar, Am Hospital 6, 34560 Fritzlar, Germany
| | - Sebastian Dendorfer
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Galgenbergstraße 30, 93053 Regensburg, Germany; Regensburg Center for Biomedical Engineering, RCBE. University and Ostbayerische Technische Hochschule Regensburg, Germany
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Paul S, Arora M, Das L, Raja BS, Kalia RB. Average Indian Glenoid Sizes Are Smaller than All Commercially Available Glenoid Components: A Systematic Review. Indian J Orthop 2023; 57:1008-1022. [PMID: 37384007 PMCID: PMC10293529 DOI: 10.1007/s43465-023-00885-8] [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: 01/26/2022] [Accepted: 03/26/2023] [Indexed: 06/30/2023]
Abstract
Background Despite the variability in glenoid sizes geographically, most of the currently available commercial glenoid component designs are based on the glenoid parameters of the Caucasian population which may not be suitable for the Indian population due to a mismatch between the prosthesis and native anatomy. The aim of the present study is to systematically review the literature to determine the average glenoid anthropometric parameters in the Indian population. Methods A comprehensive literature search was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines in the PubMed, EMBASE, Google Scholar, and Cochrane Library databases from the date of inception to May 2021. Any observational study conducted on the Indian population measuring the glenoid diameters, glenoid index, version, inclination, or any other glenoid measurements were included in the review. Results A total of 38 studies were included in this review. The glenoid parameters were assessed on intact cadaveric scapulae in 33 studies, on 3DCT in three studies, and 2DCT in one study. The pooled average of glenoid dimensions are as the following- the superoinferior diameter or height was 34.65 mm, anteroposterior1 diameter or maximum width was 23.72 mm, anteroposterior2 diameter or maximum width of the upper part of the glenoid was 17.05 mm, the glenoid index was 67.88, and the glenoid version was 1.75-degree retroversion. Males were having a mean height of 3.65 mm and maximum width of 2.74 mm larger than the females. A subgroup analysis revealed no significant difference between different parts of India in glenoid parameters. Conclusion The glenoid dimensions in the Indian population are smaller compared to the average European and American populations. The average glenoid maximum width of the Indian population is 1.3 mm smaller than the minimum glenoid baseplate size available in reverse shoulder arthroplasty. Glenoid components specific to the Indian market need to be designed to reduce glenoid failure attributable to the above findings. Level of evidence III.
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Affiliation(s)
- Souvik Paul
- Department of Orthopaedics, AMRI Hospitals Mukundapur, Kolkata, India
| | - Manit Arora
- Fortis Hospitals Mohali, Mohali, Punjab India
| | - Lakhsmana Das
- Department of Orthopedics, All India Institute of Medical Sciences Bhatinda, Punjab, India
| | - Balgovind S. Raja
- Department of Orthopedics, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
| | - Roop Bhusan Kalia
- Department of Orthopedics, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
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Lee HH, Park SE, Ji JH, Jun HS. Mid-term comparative study between the glenoid and humerus lateralization designs for reverse total shoulder arthroplasty: which lateralization design is better? BMC Musculoskelet Disord 2023; 24:290. [PMID: 37059977 PMCID: PMC10103464 DOI: 10.1186/s12891-023-06383-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION The complications of the conventional medialized design for reverse total shoulder arthroplasty (RSA) are increased scapular notching, and decreased external rotation and deltoid wrapping. Currently, lateralization design RSA, which avoid scapular notching and improve impingement-free range of motion, is commonly used. Especially, humeral lateralization design was most commonly used and glenoid lateralization design was preferred for glenoid abnormities. We compared mid-term clinical and radiologic outcomes of glenoid and humeral lateralization RSA in an Asian population in this study. MATERIALS AND METHODS We enrolled 124 shoulders of 122 consecutive patients (mean age 73.8 ± 6.8 years) who received glenoid or humeral lateralization RSA from May, 2012 to March, 2019. We divided these patients into two groups according to RSA using either glenoid or humeral lateralization design. These different designs were introduced consecutively in Korea. The clinical and radiological results of 60 glenoid lateralization RSA (Group I, 60 patients) and 64 humeral lateralization RSA (Group II, 62 patients) were retrospectively evaluated and also were compared between the two groups. All patients were followed for mean 3 years. RESULTS The clinical and radiologic outcomes of the two groups did not differ significantly, including scapular notching (p = 0.134). However, humeral lateralization RSA showed a larger glenoid-tuberosity (GT) distance (p = 0.000) and less distalization shoulder angle (DSA) (p = 0.035). The complication rate did not differ significantly either. But, revision surgery was performed for 2 humeral loosening in the Group II. CONCLUSION The clinical and radiologic outcomes of the two groups did not differ significantly, including scapular notching at mid-term follow-up. However, humeral lateralization design showed larger GT distance and less DSA. Humeral lateralization design RSA could preserve the normal shoulder contour due to a larger GT distance (more lateralization) and provide less deltoid tension due to less DSA (less distalization of COR).
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Affiliation(s)
- Hwan-Hee Lee
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Eun Park
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Korea.
| | - Hyun-Sik Jun
- Department of Orthopedic Surgery, The Catholic University of Korea, Seoul, Republic of Korea
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Holliday C, Marigi EM, Marigi I, Duquin TR, Sperling JW. Reverse shoulder arthroplasty using an onlay humeral prosthesis, offset humeral tray, and augmented glenoid baseplate: surgical technique and review of the impact of prosthesis design on scapular fractures following reverse shoulder arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:67-76. [PMID: 37588074 PMCID: PMC10426605 DOI: 10.1016/j.xrrt.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Reverse total shoulder arthroplasty (RSA) has become the most utilized form of arthroplasty of the shoulder. Acromial stress fractures and scapular spine stress fractures are rare, yet well-recognized complications of RSA with ongoing studies identifying whether patient factors or prosthetic designs serve as risk factors. Specifically, it remains unclear if or how the position of the humeral tray (inlay or onlay) in RSA affects rates of periscapular fractures. The purpose of this article is to describe our technique for RSA using an onlay prosthesis, a variable-offset humeral tray, and an augmented glenoid baseplate, as well as to review the published results of acromial and scapular spine fractures after RSA based on humeral implant design.
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Affiliation(s)
- Charles Holliday
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ian Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Thomas R. Duquin
- Department of Orthopaedics, State University of New York, Buffalo, NY, USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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12
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Humeral and Glenoid Version in Reverse Total Shoulder Arthroplasty: A Systematic Review. J Clin Med 2022; 11:jcm11247416. [PMID: 36556031 PMCID: PMC9781424 DOI: 10.3390/jcm11247416] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
There is increasing interest in reverse total shoulder arthroplasty (RTSA) as a reliable treatment for arthritic, rotator cuff deficient shoulders. Humeral and glenoid version are controversial parameters that can influence internal and external rotation, muscular forces, and implant stability as outcomes of RTSA. The aim of this study was to obtain an overview of the current knowledge on the effect of both humeral component version and glenoid component version and give recommendations on their most optimal degree for RTSA. A comprehensive quantitative review of the published literature on the effect of humeral version and glenoid version in RTSA was performed, to identify its influence on the range of movement, muscle forces, and intrinsic stability of the reverse prosthesis. Eleven studies were included: nine were biomechanical studies, one was a clinical-radiographic study, and one was an implant design consideration. Anterior stability can be improved by implanting the humeral component in neutral or with some anteversion. Glenoid component retroversion has been proven to reduce the likelihood of subluxation, while increasing ER and ROM at the same time. The study was conducted considering 5° anteversion; neutral; and 5°, 10°, and 20° retroversion of the glenoid component. Although a final opinion has not been yet expressed on the matter, the general consensus tends to agree on restoring 0° to 20° of retroversion of the humeral and glenoid component to yield the best outcomes.
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13
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Postoperative acromiohumeral interval affects shoulder range of motions following reverse total shoulder arthroplasty. Sci Rep 2022; 12:21011. [PMID: 36470933 PMCID: PMC9722688 DOI: 10.1038/s41598-022-25173-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) improves function and reduces pain for patients with complex shoulder problems. However, there is a lack of literature regarding the association of radiographic parameters on clinical outcomes after RTSA. The aim of this study was to analyze various radiographic parameters that may be predictive of clinical outcomes after RTSA. A total of 55 patients treated with RTSA were enrolled. Shoulder radiographic parameters were used for measurement of critical shoulder angle, acromial index, acromiohumeral interval, deltoid lever arm, acromial angulation, glenoid version, and acromial height. Preoperative and postoperative clinical outcomes were evaluated at a minimum 2-year follow-up. An analysis of correlations between radiographic parameters and clinical outcomes was then performed. A significant change in critical shoulder angle, acromiohumeral interval, and deltoid lever arm was observed between preoperative and postoperative radiographic measurements. A significant improvement was observed in all clinical outcomes and range of motions from preoperative to postoperative (all p < 0.001). A negative correlation of postoperative acromiohumeral interval with forward flexion (r = - 0.270; p = 0.046), external rotation (r = - 0.421; p = 0.001), and internal rotation (r = 0.275; p = 0.042) was observed at final follow-up. In addition, postoperative acromiohumeral interval less than 29 mm had an 86% positive predictive value of obtaining 130° of forward flexion and 45° of external rotation. It was found that postoperative acromiohumeral interval showed an association with active range of motion in patients who underwent RTSA. In particular, excessive distalization reduced forward flexion and external rotation motion of the shoulder in patients treated with RTSA.
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14
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Larose G, Fisher ND, Gambhir N, Alben MG, Zuckerman JD, Virk MS, Kwon YW. Inlay versus onlay humeral design for reverse shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:2410-2420. [PMID: 35671928 DOI: 10.1016/j.jse.2022.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since the introduction of the Grammont-style reverse total shoulder arthroplasty, the humeral stem design has been modified with improved clinical outcomes. Two distinct humeral designs have been used extensively: the inlay design, in which the humeral tray is seated within the metaphysis, and the onlay design, in which the humeral tray sits on the metaphysis at the level of the humeral neck cut. The purpose of this systematic review was to determine whether there are differences in clinical outcomes and complication rates between these designs. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to perform this systematic review. A search of MEDLINE, PubMed, and Embase was performed to identify all studies comparing the clinical results of both humeral designs. Primary outcomes included patient-reported outcome measures, shoulder range of motion, and incidence of complications. RESULTS From the 156 identified publications, 12 studies were included in the final review. A total of 1447 patients were included, with a minimum follow-up period of 12 months. At final follow-up, both implants demonstrated significant improvements in comparison to preoperative baseline. On comparison of the inlay vs. onlay groups, the American Shoulder and Elbow Surgeons score was higher in the inlay group (mean difference, 2.53 [95% confidence interval, 0.27-4.78]; P = .03). Postoperative motion, even if statistically greater in the onlay group (differences of 5° in forward flexion [P < .001], 3° in abduction [P = .003], and 4° in external rotation [P < .001]), was not clinically different. On comparison of complications, the inlay group showed more instances of scapular notching (93 of 322 patients vs. 70 of 415 patients; odds ratio, 0.35; P < .001) but fewer scapular spine fractures (26 of 727 patients vs. 21 of 559 patients, P = .09). DISCUSSION Inlay and onlay humeral tray designs in reverse total shoulder arthroplasty demonstrate similar clinical improvements postoperatively. Onlay implants have a low rate of scapular notching but a higher rate of scapular spine fracture. Understanding the strengths and weaknesses of the 2 humeral tray designs is important to provide surgeons with options to tailor surgical plans for high-risk patients.
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Affiliation(s)
- Gabriel Larose
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Nina D Fisher
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Neil Gambhir
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Matthew G Alben
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Joseph D Zuckerman
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Mandeep S Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA
| | - Young W Kwon
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
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15
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Glenoid neck length in a healthy population and its association with scapular notching. J Orthop Sci 2022; 27:1010-1016. [PMID: 34364756 DOI: 10.1016/j.jos.2021.06.021] [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: 04/13/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Scapular notching is a radiographic finding associated with the use of a reverse shoulder prosthesis. The morphological characteristics of the glenoid neck have been scarcely explored as a relevant factor in relation to scapular notching. The objective of this study is to measure the length of the glenoid neck in a three-dimensional CT reconstruction of a healthy population and to simulate the scapular notching free range of motion for the "long neck" and for the "short neck" groups. METHODS CT scans of 214 shoulders were reviewed, excluding incomplete, poor quality, or altered studies. 100 CT scans were finally processed. The mean age was 51.7 years (SD 19.4; range, 15-84 years), with 49 female and 51 male patients. For each of the scapulae, four morphometric measurements were obtained: anterior glenoid neck (AGN), middle glenoid neck (MGN), posterior glenoid neck (PGN) and alternative posterior glenoid neck (aPGN). Using 3D software, we simulated a reverse shoulder prosthesis, and the scapular notching free range of motion was registered. Differences between measurements were evaluated with an unpaired t-test using StataIC16®. P-values < 0.05 were considered significant. The intraobserver and interobserver correlation was evaluated with the intraclass correlation coefficient. RESULTS The AGN measured 7.43 ± 2.52 mm (range, 1.72-13.3 mm); MGN measured 8.05 mm ± 1.93 (range, 2.92-13.2 mm); PGN measured 7.26 ± 2.6 mm (range, 2-13.4 mm); and aPGN measured 8.97 ± 2.3 mm (range, 4.08-15.4 mm). The scapular notching free range of motion for the "long neck" group was 74.98° ± 7.35 (range, 55-83°) and for the "short neck" group, it was 62.93° ± 6.84 (range, 45-70°) (p = 0.0004). CONCLUSIONS Measurement of posterior glenoid neck length exhibits excellent reliability and reproducibility, as well as being associated to the scapular notching free range of motion. STUDY DESIGN Basic, retrospective, CT images research.
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16
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Olson JJ, Galetta MD, Keller RE, Oh LS, O'Donnell EA. Systematic review of prevalence, risk factors, and management of instability following reverse shoulder arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:261-268. [PMID: 37588866 PMCID: PMC10426617 DOI: 10.1016/j.xrrt.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Since its approval for use, reverse shoulder arthroplasty (RSA) has become the primary treatment for cuff tear arthropathy, with indications expanding more recently to include revision fracture, osteoarthritis with significant glenoid bone loss, tumor, and chronic instability. Instability is a well-described postoperative complication, occurring in 1to 31% of relatively small cohorts and case series. Given the relative infrequency of instability, there remains a need for a comprehensive review of instability with a focus on risk factors and management. Our goal of this systematic review is to describe the prevalence, risk factors, and management strategies for instability following RSA. Methods A systematic review of the PubMed, EMBASE, MEDLINE, Scopus, and Cochrane Library databases was performed according to PRISMA guidelines. Inclusion criteria included primary RSA cohorts ≥ 100 patients, revision RSA cohorts of any size, and minimum 1-year follow-up. The primary outcome of interest was postoperative instability. MINORS criteria were used to assess study bias. Descriptive statistical analysis was performed with data reported as ranges. Results Seventeen studies that included 7885 cases of RSA were reviewed. The mean follow-up ranged from 12 to 84 months. Mean age ranged from 64 to 77 years old, and males represented 19 to 39% of cohorts. There were 204 (2.5%) dislocations in 7885 cases, accounting for a rate of instability from 0.4 to 49% across all studies. By intervention, instability rates ranged from 1 to 5% (primary RSA cases), 1 to 49% (revision RSA cases only), and 0.4 to 10% (mixed cohorts). Subscapularis insufficiency and proximal humerus fractures, and fracture sequelae (malunion and nonunion) were identified as risk factors for instability. Closed reduction and casting and revision RSA were reported as successful treatment strategies with acceptable rates of stable prostheses (28-100% and 55-100%, respectively, across studies). Hemiarthroplasty or resection arthroplasty due to recurrent instability was not uncommon after 2 or more episodes of instability. Conclusion Instability following RSA occurs infrequently (1-5%) following primary RSA and more commonly following revision RSA (1-49%). RSA for acute proximal humerus fracture and fracture sequelae carries a higher risk of instability. Subscapularis repair appears to be a protective factor. While instability may be successfully treated with closed management or revision RSA, recurrent instability may ultimately require hemiarthroplasty or resection arthroplasty.
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Affiliation(s)
- Jeffrey J. Olson
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Michael D. Galetta
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Rachel E. Keller
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Luke S. Oh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
| | - Evan A. O'Donnell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Sports Medicine Service, Boston, MA, USA
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17
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Como C, LeVasseur C, Kane G, Rai A, Munsch M, Gabrielli A, Hughes J, Anderst W, Lin A. Implant characteristics affect in vivo shoulder kinematics during multiplanar functional motions after reverse shoulder arthroplasty. J Biomech 2022; 135:111050. [PMID: 35313249 PMCID: PMC9064972 DOI: 10.1016/j.jbiomech.2022.111050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to determine how implant characteristics affect in vivo shoulder kinematics after reverse shoulder arthroplasty (RSA). Kinematics of the affected upper limb were measured in 32 participants during five motions (scapular plane abduction, hand-to-head, hand-to-back, internal/external rotation at 90° abduction, and circumduction) using optical motion capture. Shoulder abduction, plane of elevation, and internal/external rotation range of motion (ROM), peak angles, and continuous kinematics waveforms were calculated for each motion. Multiple regression was used to identify associations between kinematics and implant characteristics of lateralization, humeral retroversion, glenosphere size, glenosphere tilt, glenoid eccentricity, and implant neck-shaft angle (135° or 145°). Less humeral retroversion was associated with greater shoulder rotation ROM (p = 0.036) and greater plane of elevation ROM (p = 0.024) during circumduction, while less eccentricity was associated with more posterior plane of elevation during hand-to-back (p = 0.021). The 145° implant was associated with greater internal/external shoulder rotation ROM (p < 0.001), greater internal shoulder rotation (p = 0.002), and greater plane of elevation ROM (p = 001) during the hand-to-back. The 145° implant was also associated with more internal/external rotation ROM (p = 0.043) during shoulder rotation and more abduction ROM during circumduction (p = 0.043). During the hand-to-back motion, individuals having 135° neck-shaft angle implants were more abducted from 21 to 51% of the motion and were less internally rotated from 70 to 100% of the motion, while more lateralization was associated with less internal rotation from 90 to 100% of the motion. Retroversion and implant neck-shaft angle are the primary implant characteristics associated with in vivo shoulder kinematics during complex motions after RSA.
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Affiliation(s)
- Christopher Como
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clarissa LeVasseur
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Gillian Kane
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ajinkya Rai
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Maria Munsch
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Alexandra Gabrielli
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Jonathan Hughes
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - William Anderst
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA.
| | - Albert Lin
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
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18
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The Evolution of Reverse Total Shoulder Arthroplasty-From the First Steps to Novel Implant Designs and Surgical Techniques. J Clin Med 2022; 11:jcm11061512. [PMID: 35329837 PMCID: PMC8949196 DOI: 10.3390/jcm11061512] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose of Review: The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. Recent findings: Over the past decade, worldwide implantation rates of reverse total shoulder arthroplasty have drastically increased for various shoulder pathologies. While Paul Grammont’s design principles first published in 1985 for reverse total shoulder arthroplasty remained unchanged, several adjustments were made to address postoperative clinical and biomechanical challenges such as implant glenoid loosening, scapular notching, or limited range of motion in order to maximize functional outcomes and increase the longevity of reverse total shoulder arthroplasty. However, the adequate and stable fixation of prosthetic components can be challenging, especially in massive osteoarthritis with concomitant bone loss. To overcome such issues, surgical navigation and patient-specific instruments may be a viable tool to improve accurate prosthetic component positioning. Nevertheless, larger clinical series on the accuracy and possible complications of this novel technique are still missing.
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Moroder P, Urvoy M, Raiss P, Werthel JD, Akgün D, Chaoui J, Siegert P. Patient Posture Affects Simulated ROM in Reverse Total Shoulder Arthroplasty: A Modeling Study Using Preoperative Planning Software. Clin Orthop Relat Res 2022; 480:619-631. [PMID: 34669618 PMCID: PMC8846281 DOI: 10.1097/corr.0000000000002003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/16/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Component selection and placement in reverse total shoulder arthroplasty (RTSA) is still being debated. Recently, scapulothoracic orientation and posture have emerged as relevant factors when planning an RTSA. However, the degree to which those parameters may influence ROM and whether modifiable elements of implant configuration may be helpful in improving ROM among patients with different postures have not been thoroughly studied, and modeling them may be instructive. QUESTIONS/PURPOSES Using a dedicated expansion of a conventional preoperative planning software, we asked: (1) How is patient posture likely to influence simulated ROM after virtual RTSA implantation? (2) Do changes in implant configuration, such as humeral component inclination and retrotorsion, or glenoid component size and centricity improve the simulated ROM after virtual RTSA implantation in patients with different posture types? METHODS In a computer laboratory study, available whole-torso CT scans of 30 patients (20 males and 10 females with a mean age of 65 ± 17 years) were analyzed to determine the posture type (Type A, upright posture, retracted scapulae; Type B, intermediate; Type C, kyphotic posture with protracted scapulae) based on the measured scapula internal rotation as previously described. The measurement of scapular internal rotation, which defines these posture types, was found to have a high intraclass correlation coefficient (0.87) in a previous study, suggesting reliability of the employed classification. Three shoulder surgeons each independently virtually implanted a short, curved, metaphyseal impaction stem RTSA in each patient using three-dimensional (3D) preoperative surgical planning software. Modifications based on the original component positioning were automatically generated, including different humeral component retrotorsion (0°, 20°, and 40° of anatomic and scapular internal rotation) and neck-shaft angle (135°, 145°, and 155°) as well as glenoid component configuration (36-mm concentric, 36-mm eccentric, and 42-mm concentric), resulting in 3720 different RTSA configurations. For each configuration, the maximum potential ROM in different planes was determined by the software, and the effect of different posture types was analyzed by comparing subgroups. RESULTS Irrespective of the RTSA implant configuration, the posture types had a strong effect on the calculated ROM in all planes of motion, except for flexion. In particular, simulated ROM in patients with Type C compared with Type A posture demonstrated inferior adduction (median 5° [interquartile range -7° to 20°] versus 15° [IQR 7° to 22°]; p < 0.01), abduction (63° [IQR 48° to 78°] versus 72° [IQR 63° to 82°]; p < 0.01), extension (4° [IQR -8° to 12°] versus 19° [IQR 8° to 27°]; p < 0.01), and external rotation (7° [IQR -5° to 22°] versus 28° [IQR 13° to 39°]; p < 0.01). Lower retrotorsion and a higher neck-shaft angle of the humeral component as well as a small concentric glenosphere resulted in worse overall ROM in patients with Type C posture, with severe restriction of motion in adduction, extension, and external rotation to below 0°. CONCLUSION Different posture types affect the ROM after simulated RTSA implantation, regardless of implant configuration. An individualized choice of component configuration based on scapulothoracic orientation seems to attenuate the negative effects of posture Type B and C. Future studies on ROM after RTSA should consider patient posture and scapulothoracic orientation. CLINICAL RELEVANCE In patients with Type C posture, higher retrotorsion, a lower neck-shaft angle, and a larger or inferior eccentric glenosphere seem to be advantageous.
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Affiliation(s)
- Philipp Moroder
- Department for Shoulder and Elbow Surgery, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Patric Raiss
- Orthopädische Chirurgie München, Munich, Germany
| | - Jean-David Werthel
- Hôpital Ambroise Paré, Boulogne-Billancourt, France
- Ramsay Générale de Santé, Clinique La Montagne, Courbevoie, France
| | - Doruk Akgün
- Department for Shoulder and Elbow Surgery, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Paul Siegert
- Department for Shoulder and Elbow Surgery, Charité - Universitätsmedizin, Berlin, Germany
- 1st Orthopaedic Department, Orthopaedic Hospital Speising, Vienna, Austria
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20
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Does Humeral Component Version Affect Range of Motion and Clinical Outcomes in Reverse Total Shoulder Arthroplasty? A Systematic Review. J Clin Med 2021; 10:jcm10245745. [PMID: 34945040 PMCID: PMC8703663 DOI: 10.3390/jcm10245745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prosthesis selection, design, and placement in reverse total shoulder arthroplasty (RTSA) affect post-operative results. The aim of this systematic review was to evaluate the influence of the humeral stem version and prosthesis design (inlay vs. onlay) on shoulder function following RTSA. METHODS A systematic review of the literature on post-operative range of motion (ROM) and functional scores following RTSA with specifically known humeral stem implantations was performed using MEDLINE, Pubmed, and Embase databases, and the Cochrane Library. Functional scores included were Constant scores (CSs) and/or American Shoulder and Elbow Surgeons (ASES) scores. The patients were organised into three separate groups based on the implanted version of their humeral stem: (1) less than 20° of retroversion, (2) 20° of retroversion, and (3) greater than 20° of retroversion. RESULTS Data from 14 studies and a total of 1221 shoulders were eligible for analysis. Patients with a humeral stem implanted at 20° of retroversion had similar post-operative mean ASES (75.8 points) and absolute CS (68.1 points) compared to the group with humeral stems implanted at less than 20° of retroversion (76 points and 62.5 points; p = 0.956 and p = 0.153) and those implanted at more than 20° of retroversion (73.3 points; p = 0.682). Subjects with humeral stem retroversion at greater than 20° tended towards greater active forward elevation and external rotation compared with the group at 20° of retroversion (p = 0.462) and those with less than 20° of retroversion (p = 0.192). Patients with an onlay-type RTSA showed statistically significantly higher mean post-operative internal rotation compared to patients with inlay-type RTSA designs (p = 0.048). Other functional scores and forward elevation results favoured the onlay-types, but greater external rotation was seen in inlay-type RTSA designs (p = 0.382). CONCLUSIONS Humeral stem implantation in RTSA at 20° of retroversion and greater appears to be associated with higher post-operative outcome scores and a greater range of motion when compared with a retroversion of less than 20°. Within these studies, onlay-type RTSA designs were associated with greater forward elevation but less external rotation when compared to inlay-type designs. However, none of the differences in outcome scores and range of motion between the humeral version groups were statistically significant.
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Siebenbürger G, Fleischhacker E, Stumpf U, Helfen T, Böcker W, Ockert B. Screw-Tip Augmented Locked Plating Versus Primary Reverse Total Shoulder Arthroplasty in Displaced Proximal Humeral Fractures: A Retrospective Comparative Cohort Study With a Mean Follow-Up of 39 Months. Geriatr Orthop Surg Rehabil 2021; 12:21514593211039026. [PMID: 35070475 PMCID: PMC8781273 DOI: 10.1177/21514593211039026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction This study compared the clinical and radiologic outcomes of screw-tip augmented locking plate osteosynthesis (STA) vs primary reverse total shoulder arthroplasty (RSA) in elderly patients with displaced proximal humeral fractures. Methods 60 patients (age >65 years) with a displaced proximal humeral fracture underwent open reduction and internal fixation with locking plate and fluoroscopy controlled screw-tip augmentation. Sixty matched individuals (age, gender, fracture pattern, and mean follow-up) treated by RSA for fractures were identified from the institutional database and outcomes as well as occurring complications and need for revision surgery were compared. Results At 39 months’ follow-up, 25 patients in the STA group (mean age 74.5 ± 12 years, 76.7% woman) showed a mean Constant Score (CS) of 68 ± 18.8 points. Mean %CS compared to the contralateral side was 81.6 ± 19.8%. Of 60 matched individuals in the RSA group, 22 patients (mean age 78.9 ± 8.2 years, 76.7% woman) showed a mean CS of 60.6 ± 21.2 points (P = .33), and the mean %CS compared to the contralateral side was 81.6 (74.7 ± 18.6)% (P = .14). The overall complication rate in STA group was 32% (secondary varus or valgus displacement >10°, n = 4, avascular necrosis, n = 4). In RSA group, the overall complication rate was 4.5% (P = <.05). We observed one early onset infection. Revision surgery with removal of the prosthesis and PMMA spacer implantation for two-stage revision was necessary. The follow-up rate was 41.7 vs 36.7%. Conclusions Screw-tip augmented locked plating and reverse total shoulder arthroplasty result in comparable satisfying functional outcome 3 years following a displaced proximal humeral fracture in elderly patients. However, we noted a higher complication and revision rate in the STA group. In contrast, primary reversed shoulder arthroplasty resulted in a lower rate of complications and revisions, which may be beneficial in elderly patients.
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Affiliation(s)
- Georg Siebenbürger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Evi Fleischhacker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Ulla Stumpf
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Tobias Helfen
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Ben Ockert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
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22
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Michel PA, Katthagen JC, Schliemann B, Wilkens S, Frank A, Heilmann LF, Dyrna F, Raschke MJ. Biomechanical Value of a Protective Proximal Humeral Cerclage in Reverse Total Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10194600. [PMID: 34640617 PMCID: PMC8509515 DOI: 10.3390/jcm10194600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/26/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022] Open
Abstract
Reverse shoulder arthroplasty (RSA) is a commonly performed salvage procedure for failed proximal humeral fracture fixation. The rate of intraoperative periprosthetic fractures is higher compared to primary RSA. The goal of this study was to investigate the biomechanical value of a protective cerclage during stem impaction in a revision surgery setting. Twenty-eight fresh-frozen human humeri were used to assess different configurations for steel wire and FiberTape cerclages. A custom-built biomechanical test setup simulated the mallet strikes during the stem impaction process with the Univers Revers prothesis stem. The mallet energy until the occurrence of a first crack was not different between groups. The total energy until progression of the fracture distally to the cerclage was significantly higher in the cerclage groups compared to the native humerus (9.5 J vs. 3.5 J, respectively; p = 0.0125). There was no difference between the steel wire and FiberTape groups (11.4 J vs. 8.6 J, respectively; p = 0.2695). All fractures were located at the concave side of the stem at the metaphyseal calcar region. This study demonstrates that a protective cerclage can successfully delay the occurrence of a fracture during stem impaction in reverse shoulder arthroplasty. A FiberTape cerclage is biomechanically equally efficient compared to a steel wire cerclage.
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23
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Role of Subscapularis Tendon Repair in Reverse Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2021; 29:604-608. [PMID: 34014848 DOI: 10.5435/jaaos-d-20-01151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/30/2021] [Indexed: 02/01/2023] Open
Abstract
In anatomic total shoulder arthroplasty (TSA), subscapularis repair is essential for shoulder stability and function postoperatively; however, the role of subscapularis repair in reverse TSA remains unclear. Some evidence suggests that subscapularis repair is associated with improved postoperative stability and range of motion, whereas other evidence indicates that repair is unnecessary and has no effect on clinical outcomes. In this review, we will analyze the existing literature addressing subscapularis repair during reverse TSA and discuss the effect of medialized and lateralized prosthesis designs on the utility of tendon repair.
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24
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Colliton EM, Jawa A, Kirsch JM. Acromion and Scapular Spine Fractures Following Reverse Total Shoulder Arthroplasty. Orthop Clin North Am 2021; 52:257-268. [PMID: 34053571 DOI: 10.1016/j.ocl.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reverse total shoulder arthroplasty (RSA) continues to see tremendous growth as the indications have expanded. A variety of complications have been described, including fractures of the acromion or scapular spine. These fractures are painful and can compromise shoulder stability and functional outcomes following RSA. Multiple studies have recently investigated the incidence, risk factors, and treatment strategies for these injuries. In this article, the authors review current literature and discuss the incidence, cause, associated risk factors, treatment options, and outcomes following fractures of the acromion or scapular spine after RSA.
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Affiliation(s)
- Eileen M Colliton
- Department of Orthopaedic Surgery, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA; Boston Sports and Shoulder Center, 840 Winter Street, Waltham, MA 02451, USA.
| | - Jacob M Kirsch
- Department of Orthopaedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA; Boston Sports and Shoulder Center, 840 Winter Street, Waltham, MA 02451, USA
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25
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McFarland EG, Meshram P, Rojas J, Joseph J, Srikumaran U. Reverse Total Shoulder Arthroplasty without Bone-Grafting for Severe Glenoid Bone Loss in Patients with Osteoarthritis and Intact Rotator Cuff: A Concise 5-Year Follow-up of a Previous Report. J Bone Joint Surg Am 2021; 103:581-585. [PMID: 33684084 DOI: 10.2106/jbjs.20.01042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward G McFarland
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore Maryland
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26
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Factors Influencing Appropriate Implant Selection and Position in Reverse Total Shoulder Arthroplasty. Orthop Clin North Am 2021; 52:157-166. [PMID: 33752837 DOI: 10.1016/j.ocl.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reverse shoulder arthroplasty has increased in popularity and has provided improved but somewhat variable results. These variable outcomes may be related to many factors, including implant design, component positioning, specific indication, and patient anatomy. The original Grammont design provided a solution to the high failure rate at the time but was found to have a high rate of scapular notching and poor restoration of rotation. Modern lateralized designs are more consistent in reducing scapular notching while improving range of motion, especially in regards to external rotation. This review article summarizes the effects of modern reverse shoulder prostheses on outcomes.
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27
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Sodhi N, Mont MA. Shoulder replacement survivorship. THE LANCET. RHEUMATOLOGY 2020; 2:e513-e514. [PMID: 38273614 DOI: 10.1016/s2665-9913(20)30214-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/24/2020] [Indexed: 01/27/2024]
Affiliation(s)
- Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New York, NY, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY 10075, USA.
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