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Colasanti CA, Mercer NP, Contreras E, Simovitch RW, Zuckerman JD. Reverse shoulder arthroplasty design-inlay vs. onlay: does it really make a difference? J Shoulder Elbow Surg 2024; 33:2073-2085. [PMID: 38582254 DOI: 10.1016/j.jse.2024.02.027] [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: 11/12/2023] [Revised: 01/28/2024] [Accepted: 02/12/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The design of reverse shoulder arthroplasty (RSA) implants has evolved significantly over the past 50 years. Today there are many options available that differ in design of the glenoid and humeral components, fixation methods, sizes, and modularity. With respect to the humeral component, the literature has generally focused on the differences between inlay and onlay designs and the potential impact on outcomes. However, inlay and onlay design represents only one factor of many. METHODS It is our hypothesis that separating onlay and inlay designs into 2 distinct entities is an oversimplification as there can be a wide overlap of the 2 designs, depending on surgical technique and the implant selected. As such, the differences between inlay and onlay designs should be measured in absolute terms-meaning combined distalization and lateralization. RESULTS By reviewing the many factors that can contribute to the glenosphere-humerus relationship, the role of inlay and onlay humeral designs as an important distinguishing feature is shown to be limited. Preliminary studies suggest that the amount of distalization and lateralization of the construct may be the most accurate method of describing the differences in the constructs. CONCLUSIONS Inlay and onlay humeral component design represents only one factor of many that may impact outcomes. A more accurate method of defining specific design and technique factors in RSA is the degree of lateralization and distalization.
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Affiliation(s)
| | - Nathaniel P Mercer
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Erik Contreras
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ryan W Simovitch
- Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, FL, USA
| | - Joseph D Zuckerman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
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Oladimeji AE, Amoo-Achampong K, Ode GE. Impact of critical shoulder angle in shoulder pathology: a current concepts review. JSES Int 2024; 8:287-292. [PMID: 38464445 PMCID: PMC10920144 DOI: 10.1016/j.jseint.2023.11.002] [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: 03/12/2024] Open
Abstract
Background This review aims to describe the origin and development of critical shoulder angle (CSA) and its correlation with different shoulder pathologies. Current literature is inconclusive in characterizing the role of CSA in predicting pathology and surgical outcomes. Methods A literature search of both historical and more contemporary research articles on CSA was conducted to compare data points on the impact of CSA on shoulder pathology and postoperative clinical outcomes. This compilation of studies ranges from retrospective reviews to case series as well as cadaveric imaging studies. Results The CSA is a reliable radiographic measure in predicting shoulder pathology in correctly oriented radiographs. Surgically modifying the CSA with arthroscopic lateral acromioplasty and results has largely shown improved recovery of strength postoperatively as with no increase in postsurgical complication rates. However, it remains unclear whether surgical alteration of CSA has a role in preventing clinical failure after arthroscopic procedures such as acromioplasty and rotator cuff repair as well as following shoulder arthroplasty. Discussion Stronger conclusions regarding the prognostic utility of CSA are limited by the fact that most studies evaluating CSA are smaller retrospective cohorts. Moving forward, randomized controlled trials being conducted may offer greater insight as to how CSA can improve patient-reported outcomes postoperatively.
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Affiliation(s)
- Akinola E Oladimeji
- Sports Medicine and Shoulder Surgery Division, Hospital for Special Surgery, New York, NY, USA
| | - Kelms Amoo-Achampong
- Sports Medicine and Shoulder Surgery Division, Hospital for Special Surgery, New York, NY, USA
| | - Gabriella E Ode
- Sports Medicine and Shoulder Surgery Division, Hospital for Special Surgery, New York, NY, USA
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Longo UG, Franceschetti E, Carnevale A, Schena E, Cozza G, Perricone G, Cardinale ME, Papalia R. Influence of Lateralization and Distalization on Joint Function after Primary Reverse Total Shoulder Arthroplasty. Bioengineering (Basel) 2023; 10:1409. [PMID: 38136000 PMCID: PMC10740542 DOI: 10.3390/bioengineering10121409] [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: 10/16/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of this study was to investigate how lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are related to clinical and kinematic outcomes after reverse total shoulder arthroplasty. Thirty-three patients were evaluated at least six months postoperatively. The Single Assessment Numeric Evaluation (SANE), Constant Murley Score (CMS), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) were used. Shoulder kinematics was evaluated with a stereophotogrammetric system. LSA and DSA inter-rater reliability was analysed through the interclass correlation coefficient (ICC). Stepwise forward linear regression analysis was conducted between LSA and DSA with clinical scales and kinematic measures, between which a correlation analysis was conducted. The inter-rater reliability for LSA (mean ICC = 0.93) and DSA (mean ICC = 0.97) results were good to excellent. Greater LSA values were associated with higher peaks of internal rotation (p = 0.012, R2 = 0.188) and range of motion (ROM) (p = 0.037, R2 = 0.133). SANE (p = 0.009), CMS (p = 0.031), and SST (0.026) were positively correlated to external rotation, while VAS (p = 0.020) was negatively related. Abduction peaks were positively related to CMS (p = 0.011) and SANE (p = 0.037), as well as abduction ROM (SANE, p = 0.031; CMS, p = 0.014).
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Emiliano Schena
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Laboratory of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Giulia Cozza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Giovanni Perricone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Marco Edoardo Cardinale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
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Maksoud A, Steinlechner C, Baldwick C, Tabi W. Associations between radiographic parameters in the reverse shoulder arthroplasty and patient outcomes. Shoulder Elbow 2023; 15:19-34. [PMID: 37974644 PMCID: PMC10649507 DOI: 10.1177/17585732211057887] [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: 06/29/2021] [Revised: 09/20/2021] [Accepted: 10/08/2021] [Indexed: 11/19/2023]
Abstract
Background Various radiological parameters have been measured in the Reverse Shoulder Arthroplasty (RSA) and correlated to patient outcomes, to determine best baseplate position. Results remain unclear with respect to certain parameters such as inferior baseplate tilt. We have investigated our series of patients to clarify the relationship between radiological parameters and patient outcomes. Methods We conducted a UK based bi-centre retrospective review of 156 prostheses. Critical shoulder angle (CSA), RSA angle (RSAA), Overhang and Deltoid Lever Arm (DLA) were measured on preoperative and postoperative radiographs. Range of motion and Oxford Shoulder Score (OSS) (range 1-8 years) were obtained. We assessed for scapular notching at minimum 1 year follow up (n = 138). Results Decreased postoperative CSA and increased DLA were associated with higher OSSs (P = 0.001 and 0.019). Increased overhang and DLA were associated with increased flexion (P = 0.033 and 0.024 respectively). Multivariate analysis showed that CSA and DLA affected notching rate (P = 0.002 and 0.007). Conclusions Baseplate tilt in relation to the acromion (CSA) and DLA are the most predictive parameters for notching and OSS. We recommend considering a maximum CSA of 26 degrees to decrease notching rate and improve OSS. We recommend considering an Overhang of at least 6 mm to improve FF.
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Haeffner BD, Cueto RJ, Abdelmalik BM, Hones KM, Wright JO, Srinivasan RC, King JJ, Wright TW, Werthel JD, Schoch BS, Hao KA. The association between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:e477-e494. [PMID: 37379967 DOI: 10.1016/j.jse.2023.05.024] [Citation(s) in RCA: 1] [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: 03/06/2023] [Revised: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty (RSA) with stratification based on measurement method and implant design. METHODS This systematic review was performed using PRISMA-P guidelines. PubMed/Medline, Cochrane Trials, and Embase were queried for articles evaluating the relationship between humeral lengthening and clinical outcomes inclusive of range of motion (ROM), strength, outcome scores, and pertinent complications (acromial and scapular spine fractures, nerve injury) after RSA. The relationship between humeral lengthening and clinical outcomes was reported descriptively overall and stratified by measurement method and implant design (globally medialized vs. lateralized). A positive association was defined as increased humeral lengthening being associated with greater ROM, outcome scores, or a greater incidence of complications, whereas a negative association denoted that increased humeral lengthening was associated with poorer ROM, outcome scores, or a lower incidence of complications. Meta-analysis was performed to compare humeral lengthening between patients with and without fractures of the acromion or scapular spine. RESULTS Twenty-two studies were included. Humeral lengthening was assessed as the acromiohumeral distance (AHD), the distance from the acromion to the greater tuberosity (AGT), the acromion to the deltoid tuberosity (ADT), and the acromion to the distal humerus (ADH). Of 11 studies that assessed forward elevation, a positive association with humeral lengthening was found in 6, a negative association was found in 1, and 4 studies reported no association. Of studies assessing internal rotation (n = 9), external rotation (n = 7), and abduction (n = 4), all either identified a positive or lack of association with humeral lengthening. Studies assessing outcome scores (n = 11) found either a positive (n = 5) or no (n = 6) association with humeral lengthening. Of the studies that assessed fractures of the acromion and/or scapular spine (n = 6), 2 identified a positive association with humeral lengthening, 1 identified a negative association, and 3 identified no association. The single study that assessed the incidence of nerve injury identified a positive association with humeral lengthening. Meta-analysis was possible for AGT (n = 2) and AHD (n = 2); greater humeral lengthening was found in patients with fractures for studies using the AGT (mean difference 4.5 mm, 95% CI 0.7-8.3) but not the AHD. Limited study inclusion and heterogeneity prohibited identification of trends based on method of measuring humeral lengthening and implant design. CONCLUSION The relationship between humeral lengthening and clinical outcomes after RSA remains unclear and requires future investigation using a standardized assessment method.
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Affiliation(s)
- Brett D Haeffner
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Keegan M Hones
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | | | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
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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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7
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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: 8] [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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Lehtimäki K, Harjula J, Uurinmäki J, Kukkonen J, Löyttyniemi E, Mokka J, Tiusanen H, Äärimaa V. Radiographic geometry and clinical glenohumeral range of motion after reverse shoulder athroplasty, a retrospective cohort study. J Orthop 2021; 25:283-287. [PMID: 34121823 PMCID: PMC8175279 DOI: 10.1016/j.jor.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background The range of motion (ROM) in reverse shoulder arthroplasty (RSA), is mechanically limited by the surrounding bony obstacles especially in abduction and rotation planes. However, the clinical effect of implant positioning, prosthesis design, and individual differences in bone morphology, on ROM is obscure. The aim of this study was to investigate the correlation between radiographic geometry and clinical glenohumeral (GH) ROM after RSA. Methods RSA patients operated at Turku University Hospital during 2007–2013 were called for radiological and clinical follow-up. Pre- and postoperative true anteroposterior radiographs were obtained and the positioning of the center of rotation (COR) in relation to the surrounding bony structures was measured. Active and passive shoulder and GH abduction, flexion, internal and external rotation ROM were measured with goniometer. The Constant score (CS) and pain visual analogue scale (VAS) were recorded. The correlation between the radiographically measured parameters and the active and passive ROM and clinical outcome was statistically analyzed. Results 91 shoulders were available for analyses with a mean follow-up of 38.7 months ± SD 20 (range 12–83) months. 77% of the patients were female, the mean age was 73 (SD 9) years. The mean angle between the line of supraspinatus fossa, and the line between COR and lateral edge of the acromion (α-angle) was 127° (SD 14) and the mean angle between the lines from lateral edge of the acromion to COR, and from there to the superior edge of the greater tubercle (β-angle) was 54° (SD 11). The mean active shoulder flexion at follow-up was 118° (SD 26), abduction 104° (SD 32), external rotation 41° (SD 22), internal rotation 77° (SD 21). The mean passive GH flexion was 80° (SD 19), abduction 67° (SD 15), external rotation 31° (SD 16) and internal rotation 34° (SD 14). The mean Constant score at follow-up was 53 (SD 18) and pain VAS 2 (SD 3). The positioning of the radiographically measured COR did not statistically significantly correlate with the ROM or clinical outcome scores. Conclusions Postoperative radiographically measured two-dimensional geometry and positioning of the COR does not significantly correlate with the glenohumeral range of motion or clinical results after RSA. Level of evidence Level 3, retrospective cohort study
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Affiliation(s)
- Kaisa Lehtimäki
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Jenni Harjula
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Juha Kukkonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Jari Mokka
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Hannu Tiusanen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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Aldon-Villegas R, Ridao-Fernández C, Torres-Enamorado D, Chamorro-Moriana G. How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures. Diagnostics (Basel) 2021; 11:845. [PMID: 34066777 PMCID: PMC8151204 DOI: 10.3390/diagnostics11050845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 01/19/2023] Open
Abstract
The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.
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Affiliation(s)
- Rocio Aldon-Villegas
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Carmen Ridao-Fernández
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
| | - Dolores Torres-Enamorado
- Research Group “Women, Well-Being and Citizenship” SEJ066, Department of Nursing, University of Seville, 41930 Bormujos, Spain;
| | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, Department of Physiotherapy, University of Seville, 41009 Seville, Spain; (R.A.-V.); (G.C.-M.)
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10
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Chalmers PN, Lindsay SR, Smith W, Kawakami J, Hill R, Tashjian RZ, Keener JD. Infraspinatus and deltoid length and patient height: implications for lateralization and distalization in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:712-719. [PMID: 32711102 PMCID: PMC7854847 DOI: 10.1016/j.jse.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of muscular strength is predicated on restoration of muscle length. The purpose of this study was to describe infraspinatus and deltoid length preoperative to reverse total shoulder arthroplasty (RTSA) to guide distalization and lateralization to restore preoperative muscle length. METHODS This was a retrospective radiographic study. We measured the infraspinatus length on preoperative computed tomographic images and the deltoid length on preoperative radiographs. For all measurements, reliability was first established by comparing measurements between 2 observers, and intraclass correlation coefficients (ICCs) were calculated. We then calculated descriptive statistics for these muscle lengths and developed a formula to predict these muscle lengths from patient demographics. RESULTS We measured infraspinatus length in 97 patients and deltoid length in 108 patients. Inter-rater reliability was excellent, with all ICCs >0.886. The mean infraspinatus length was 15.5 cm (standard deviation 1.3) and ranged from 12.6-18.9 cm, whereas the deltoid length was 16.2±1.7 cm and ranged from 12.5-20.2 cm. Both infraspinatus (r = 0.775, P < .001) and deltoid length (r = 0.717, P < .001) were highly correlated with patient height but did not differ between diagnoses. Formulae developed through linear regression allowed prediction of muscle length to within 1 cm in 78% and within 2 cm in 100% for the infraspinatus and 60% and 88% for the deltoid. CONCLUSION Deltoid and infraspinatus length are variable but highly correlated with patient height. To maintain tension, 2 mm of lateralization and distalization should be added for every 6 inches (∼15 cm) of height above average for a Grammont-style RTSA.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Spencer R Lindsay
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Weston Smith
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jun Kawakami
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Ryan Hill
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
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Negligible Correlation between Radiographic Measurements and Clinical Outcomes in Patients Following Primary Reverse Total Shoulder Arthroplasty. J Clin Med 2021; 10:jcm10040809. [PMID: 33671318 PMCID: PMC7923193 DOI: 10.3390/jcm10040809] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
Previous attempts to measure lateralization, distalization or inclination after reverse total shoulder arthroplasty (rTSA) and to correlate them with clinical outcomes have been made in the past years. However, this is considered to be too demanding and challenging for daily clinical practice. Additionally, the reported findings were obtained from heterogeneous rTSA cohorts using 145° and 155° designs and are limited in external validity. The purpose of this study was to investigate the prognostic preoperative and postoperative radiographic factors affecting clinical outcomes in patients following rTSA using a 135° prosthesis design. In a multi-center design, patients undergoing primary rTSA using a 135° design were included. Radiographic analysis included center of rotation (COR), acromiohumeral distance (AHD), lateral humeral offset (LHO), distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), and glenoid and baseplate inclination. Radiographic measurements were correlated to clinical and functional outcomes, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (STT), Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) score, active forward elevation (AFE), external rotation (AER), and abduction (AABD), at a minimum 2-year follow-up. There was a significant correlation between both DSA (r = 0.299; p = 0.020) and LSA (r = −0.276; p = 0.033) and the degree of AFE at final follow-up. However, no correlation between DSA (r = 0.133; p = 0.317) and LSA (r = −0.096; p = 0.471) and AER was observed. Postoperative AHD demonstrated a significant correlation with final AFE (r = 0.398; p = 0.002) and SST (r = 0.293; p = 0.025). Further, postoperative LHO showed a significant correlation with ASES (r = −0.281; p = 0.030) and LSA showed a significant correlation with ASES (r = −0.327; p = 0.011), SANE (r = −0.308, p = 0.012), SST (r = −0.410; p = 0.001), and VAS (r = 0.272; p = 0.034) at terminal follow-up. All other correlations were found to be non-significant (p > 0.05, respectively). Negligible correlations between pre- and postoperative radiographic measurements and clinical outcomes following primary rTSA using a 135° prosthesis design were demonstrated; however, these observations are of limited predictive value for outcomes following rTSA. Subsequently, there remains a debate regarding the ideal placement of the components during rTSA to most sufficiently restore active ROM while minimizing complications such as component loosening and scapular notching. Additionally, as the data from this study show, there is still a considerable lack of data in assessing radiographic prosthesis positioning in correlation to clinical outcomes. As such, the importance of radiographic measurements and their correlation with clinical and functional outcomes following rTSA may be limited.
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Tashjian RZ, Hillyard B, Childress V, Kawakami J, Presson AP, Zhang C, Chalmers PN. Outcomes after a Grammont-style reverse total shoulder arthroplasty? J Shoulder Elbow Surg 2021; 30:e10-e17. [PMID: 32778382 PMCID: PMC7726007 DOI: 10.1016/j.jse.2020.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the factors associated with outcomes after reverse total shoulder arthroplasty (RTSA). METHODS We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We evaluated pain visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We evaluated preoperative and 2-week postoperative radiographs for glenoid inclination (GI), medialization as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance. We performed inter- and intrarater reliabilities via intraclass correlation coefficients (ICCs) and conducted a multivariable analysis. RESULTS We included 230 RTSAs in the analysis, with 70% follow-up at a median of 3.4 years. Reliability was acceptable with all ICCs >.678. Increased postoperative GI was significantly associated with increased VAS pain postoperatively (P = .008). Increased distalization was associated with an increased rate of complications and reoperations (P = .032). Younger age (P = .008), female gender (P = .009), and lower body mass index (BMI) (P = .006) were associated with worse ASES scores. Female gender (P < .001) and lower BMI (P = .039) were associated with worse SST scores. Female gender (P = .013) and lower BMI (P = .005) were associated with worse VAS-pain scores. CONCLUSION Age, gender, and BMI are associated with outcome after RTSA. In this retrospective analysis of a Grammont-style RTSA, superior inclination is associated with increased pain postoperatively, whereas excessive arm lengthening is associated with increased risk for complication or reoperation.
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Affiliation(s)
- Robert Z Tashjian
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Bradley Hillyard
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Victoria Childress
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jun Kawakami
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Deptartment of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
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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: 26] [Impact Index Per Article: 6.5] [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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