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Bauer S, Blakeney WG, Lannes X, Wang AW, Shao W. Optimizing stability and motion in reverse shoulder arthroplasty with a 135° neck-shaft-angle: a computer model study of standard versus retentive humeral inserts. JSES Int 2024; 8:1087-1094. [PMID: 39280143 PMCID: PMC11401560 DOI: 10.1016/j.jseint.2024.06.003] [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: 09/18/2024] Open
Abstract
Background There has been a trend to shift from a 155° and 145° neck-shaft-angle (NSA) to a more "anatomical" reverse shoulder arthroplasty with less distalization and a 135° NSA. Multiple studies have shown that a 135° NSA is beneficial for motion. There are some concerns about primary implant stability with a 135° NSA. When instability is detected, increasing the tension with thicker inlays or changing the NSA to 145° are possible solutions. A retentive 135° (Ret135) inlay may be an alternative to avoiding increased distalization; however, retentive liners are widely regarded as salvage options reducing range of motion (ROM) and avoided by most surgeons. The hypothesis of this study was that a retentive 135° insert of the tested implant system may not have drawbacks for impingement-free ROM compared to a standard 145° insert (Sta145). Methods In this computer model study, 22 computed tomographic scans (11 males/11 females) were used to create models with a constant humeral stem (Perform/Stryker) and +3 mm lateralized baseplate +36 mm glenosphere for females and +6 mm lateralized baseplate +39 mm glenosphere for males using Blueprint software (Imascap, Brest, France). A Ret135, standard 135° (Sta135), and Sta145 (+10°) insert were compared for adduction (ADD), extension (EXT), external rotation (ER), and internal rotation (IR) all with the arm at the side as well as for combined IR (CIR = EXT + IR) and combined notching relevant (CNR) ROM (EXT + ER + IR + ADD). Results Sta135 showed significantly better ROM for ER, IR, ADD, EXT, CNR ROM, and CIR compared to Ret135 (P < .05) and significantly better EXT and ADD compared to Sta145 (P < .0001). Comparison of Ret135 and Sta145 showed equivalent ROM performance, which was slightly better but nonsignificant for ADD (P = .16), EXT (P = .31), CNR ROM (P = .7), and CIR (P = .54) in favor of Ret135. Isolated IR (P = .39) and ER (P = .32) were slightly better but nonsignificant in favor of a Sta145. Conclusion For this implant system tested in a computer model, a 135° standard liner offers the best ROM. A 135° retentive liner maintains at least equivalent CIR and motion to prevent notching compared to a standard 145° liner. 135° retentive liners are more than salvage options and may help to prevent distalization and overtensioning by increased liner thickness.
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Affiliation(s)
- Stefan Bauer
- Centre de l'épaule et du membre supérieur de la Côte, Ensemble Hospitalier de la Côte, Morges, Switzerland
- School of Surgery, University of Western Australia, Perth, WA, Australia
| | - William G Blakeney
- School of Surgery, University of Western Australia, Perth, WA, Australia
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Xavier Lannes
- Centre de l'épaule et du membre supérieur de la Côte, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Allan W Wang
- School of Surgery, University of Western Australia, Perth, WA, Australia
| | - Wei Shao
- Centre de l'épaule et du membre supérieur de la Côte, Ensemble Hospitalier de la Côte, Morges, Switzerland
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Bauer S, Blakeney WG, Meylan A, Mahlouly J, Wang AW, Walch A, Tolosano L. Humeral head size predicts baseplate lateralization in reverse shoulder arthroplasty: a comparative computer model study. JSES Int 2024; 8:335-342. [PMID: 38464453 PMCID: PMC10920133 DOI: 10.1016/j.jseint.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background In reverse shoulder arthroplasty (RSA), the ideal combination of baseplate lateralization (BL), glenosphere size (GS), and glenosphere overhang (GOH) with a commonly used 145° neck shaft angle (NSA) is unclear. This is the first study evaluating correlations of body height (BH), humeral head size (HS), glenoid height (GH), and association of gender with best glenoid configurations for range of motion (ROM) maintaining anatomic lateralization (aLAT) for optimized muscle length in 145° and less distalized 135° RSA. Methods In this computer model study, 22 computed tomographies without joint narrowing were analyzed (11 male/female). A standardized semi-inlay 145° platform stem was combined with 20 glenoid configurations (baseplate [B] 25, 25 + 3/+6 lateralized [l], 29, 29 + 3/6l combined with glenosphere 36, 36 + 2 eccentric [e], 36 + 3l, 39, 39 + 3e, 39 + 3l , 42, 42 + 4e). Abduction-adduction, flexion-extension, external rotation-internal rotation, total ROM (TROM), and total notching relevant (TNR) ROM were computed, best TROM models respecting aLAT (-1 mm to +1 mm) and HS/GH recorded. Second, the 145° models (Ascend Flex stem; Stryker, Kalamazoo, MI, USA) were converted and compared to a 135° inlay RSA (New Perform stem; Stryker, Kalamazoo, MI, USA) maintaining GOH (6.5-7 mm) and aLAT. Results Best 145° models had eccentric glenospheres (mean BL: 3.5 mm, GOH 8.8 mm, GS 38.1 mm, distalization 23 mm). The 135° models had concentric glenospheres, mean BL 3.8 mm, GOH 6.9 mm, GS 39.7 mm, and distalization 14.1 mm. HS showed the strongest positive correlation with BL in 145° and 135° models (0.65/0.79). Despite reduced GOH in smaller females with a 135° NSA, adduction, external rotation, extension, TNR ROM, and TROM were significantly increased (P = .02, P = .005, P = .005, P = .004, P = .003), abduction however reduced (P = .02). The same trends were seen for males. Conclusion HS is a practical measure in surgery or preoperatively, and the strong positive correlation with BL is a useful planning aid. Despite reduction of GOH, conversion to a less distalized 135° NSAinlay design is powerful to maintain and even significantly increase all components of TNR ROM (extension/external rotation/adduction) in small females with the drawback of reduced abduction which may however be compensated by scapula motion. Lateralization with a less distalized 135° RSA optimizes muscle length, may facilitate subscapularis repair, and maintains highest rigid body motion.
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Affiliation(s)
- Stefan Bauer
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
- School of Surgery, University of Western Australia, Perth, WA, Australia
| | - William G. Blakeney
- School of Surgery, University of Western Australia, Perth, WA, Australia
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Arnaud Meylan
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jaad Mahlouly
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Allan W Wang
- School of Surgery, University of Western Australia, Perth, WA, Australia
| | - Arnaud Walch
- CHU de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Luca Tolosano
- Chirurgie de l’épaule et du coude, Service d'Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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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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Bauer S, Ernstbrunner L. The Evolution of Reverse Total Shoulder Arthroplasty-Where Do We Stand and What Comes Next? J Clin Med 2023; 12:jcm12051945. [PMID: 36902731 PMCID: PMC10003690 DOI: 10.3390/jcm12051945] [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: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Over 35 years ago, the pioneer Paul Grammont from Lyon published his ideas of a reversed semi-constraint prosthesis improving the moment arm of the deltoid by medializing the center of rotation and lengthening of the arm and thus increasing deltoid muscle tension [...].
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Affiliation(s)
- Stefan Bauer
- Service d’Orthopédie et de Traumatologie, Chirurgie de l’Épaule, Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
- Medical School, University of Western Australia, 35 Sterling Highway, Perth, WA 6009, Australia
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Melbourne, VIC 3050, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence:
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Challenges for Optimization of Reverse Shoulder Arthroplasty Part I: External Rotation, Extension and Internal Rotation. J Clin Med 2023; 12:jcm12051814. [PMID: 36902601 PMCID: PMC10003696 DOI: 10.3390/jcm12051814] [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: 12/23/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
A detailed overview of the basic science and clinical literature reporting on the challenges for the optimization of reverse shoulder arthroplasty (RSA) is presented in two review articles. Part I looks at (I) external rotation and extension, (II) internal rotation and the analysis and discussion of the interplay of different factors influencing these challenges. In part II, we focus on (III) the conservation of sufficient subacromial and coracohumeral space, (IV) scapular posture and (V) moment arms and muscle tensioning. There is a need to define the criteria and algorithms for planning and execution of optimized, balanced RSA to improve the range of motion, function and longevity whilst minimizing complications. For an optimized RSA with the highest function, it is important not to overlook any of these challenges. This summary may be used as an aide memoire for RSA planning.
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Bauer S, Blakeney WG, Wang AW, Ernstbrunner L, Corbaz J, Werthel JD. Challenges for Optimization of Reverse Shoulder Arthroplasty Part II: Subacromial Space, Scapular Posture, Moment Arms and Muscle Tensioning. J Clin Med 2023; 12:1616. [PMID: 36836151 PMCID: PMC9958610 DOI: 10.3390/jcm12041616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
In part II of this comprehensive review on the optimization of reverse shoulder arthroplasty (RSA), we focus on three other challenges: 1. "Conservation of sufficient subacromial and coracohumeral space"; 2. "Scapular posture"; and 3. "Moment arms and muscle tensioning". This paper follows a detailed review of the basic science and clinical literature of the challenges in part I: 1. "External rotation and extension" and 2. "Internal rotation". "Conservation of sufficient subacromial and coracohumeral space" and "Scapular posture" may have a significant impact on the passive and active function of RSA. Understanding the implications of "Moment arms and muscle tensioning" is essential to optimize active force generation and RSA performance. An awareness and understanding of the challenges of the optimization of RSA help surgeons prevent complications and improve RSA function and raise further research questions for ongoing study.
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Affiliation(s)
- Stefan Bauer
- Service d’Orthopédie et de Traumatologie, Chirurgie de l’Épaule, Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
- Medical School, University of Western Australia, 35 Sterling Highway, Perth, WA 6009, Australia
| | - William G. Blakeney
- Medical School, University of Western Australia, 35 Sterling Highway, Perth, WA 6009, Australia
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Allan W. Wang
- Medical School, University of Western Australia, 35 Sterling Highway, Perth, WA 6009, Australia
| | - Lukas Ernstbrunner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia
| | - Jocelyn Corbaz
- Service d’Orthopédie et de Traumatologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Jean-David Werthel
- Service d’Orthopédie et de Traumatologie, Hôpital Ambroise Paré, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
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