A kinematic and electromyographic comparison of a Grammont-style reverse arthroplasty combined with a l’Episcopo transfer compared to a lateralized humeral component reverse for restoration of active external rotation

2021 ◽  
Author(s):  
Giovanni Merolla ◽  
Francesco Cuoghi ◽  
George S. Athwal ◽  
Ilaria Parel ◽  
Maria V. Filippi ◽  
...  
Keyword(s):  
External Rotation ◽  
Humeral Component ◽  
Reverse Arthroplasty

Onlay versus inlay humeral components in reverse shoulder arthroplasty: A systematic review and meta-analysis

2021 ◽  
pp. 175857322110671
Author(s):  
Garrett R Jackson ◽  
Joshua Meade ◽  
Bradley L Young ◽  
David P Trofa ◽  
Shadley C Schiffern ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Meta Analysis ◽  
Reverse Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Forward Flexion ◽  
Scapular Fractures ◽  
Humeral Component ◽  
Significant Difference ◽  
Vas Scores

Background Advances have been made to the traditional inlay Grammont Reverse Shoulder Arthroplasty (RSA) design such as the onlay humeral component prosthesis. Currently, there is no agreement in the literature regarding the best option for the humeral component when comparing inlay and onlay designs. This review compares the outcomes and complications between onlay versus inlay humeral components for RSA. Methods A literature search was conducted using PubMed and Embase. Only studies reporting outcomes comparing onlay versus inlay RSA humeral components were included. Results Four studies with 298 patients (306 shoulders) were included. Onlay humeral components were associated with better external rotation (ER) ( p < 0.0001). No significant difference in forward flexion (FF) or abduction was found. Constant scores (CS) and VAS scores did not differ. Increased scapular notching was found in the inlay group (23.18%) versus the onlay group (7.74%) ( p = 0.02). Postoperative scapular fractures and acromial fractures did not differ. Conclusion Onlay and inlay RSA designs are associated with improved postoperative range of motion (ROM). Onlay humeral designs may be associated with greater ER and lower rate of scapular notching; however, no difference was found in Constant and VAS scores, so further studies are required to assess the clinical significance of these differences.

The biomechanical effectiveness of tendon transfers to restore rotation after reverse shoulder arthroplasty: latissimus versus lower trapezius

2020 ◽  
pp. 175857322094625
Author(s):  
Kevin Chan ◽  
G Daniel G Langohr ◽  
George S Athwal ◽  
James A Johnson
Keyword(s):  
Internal Rotation ◽  
Shoulder Arthroplasty ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Pectoralis Major ◽  
Tendon Transfers ◽  
Humeral Component ◽  
Pectoralis Major Transfer ◽  
Lower Trapezius

Background The purpose of this biomechanical simulator study was primarily to compare latissimus dorsi to lower trapezius tendon transfers for active external rotation and the pectoralis major transfer for internal rotation after reverse shoulder arthroplasty. Secondarily, the role of humeral component lateralization on transfer function was assessed. Methods Eight rotator cuff deficient cadavers underwent reverse shoulder arthroplasty with an adjustable lateralization humeral component. Latissimus dorsi and lower trapezius transfers were compared for active external rotation restoration and pectoralis major transfer for internal rotation restoration. Internal rotation/external rotation torques were measured for each lateralization at varying abduction and internal rotation/external rotation ranges-of-motion. Results The lower trapezius transfer generated, on average, 1.6 ± 0.2 nm more torque than the latissimus dorsi transfer (p < 0.001). The internal rotation/external rotation torques of all tendon transfers decreased as abduction increased (p < 0.01). At 0° elevation, reverse shoulder arthroplasty humeral component lateralization had a significant positive effect on tendon transfer torque at 60° internal rotation and external rotation (p < 0.01). Discussion Both the lower trapezius and the latissimus dorsi tendon transfers were effective in restoring active external rotation after reverse shoulder arthroplasty; however, the lower trapezius generated significantly more torque. Additionally, the pectoralis major transfer was effective in restoring active internal rotation. All tendon transfers were optimized with greater humeral component lateralization.

Does the triceps-on approach affect alignment in total elbow arthroplasty? A cadaveric study

2018 ◽  
Vol 11 (5) ◽  
pp. 372-377
Author(s):  
Andrew King ◽  
Jonathan P Evans ◽  
Simon J Booker ◽  
James CS Beazley ◽  
Robin JS Jones ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
External Rotation ◽  
Total Elbow Arthroplasty ◽  
Anatomical Landmarks ◽  
Transepicondylar Axis ◽  
Elbow Arthroplasty ◽  
Humeral Component ◽  
Significant Difference ◽  
Flexion Extension ◽  
Centre Of Rotation

Background The triceps-on approach for total elbow arthroplasty has gained popularity due to the theoretical benefit of preserving the extensor mechanism. However, there is concern that the exposure may be reduced in comparison to a triceps-off approach and may affect the implant alignment achieved. Method Total elbow arthroplasties were implanted in 18 randomised, paired cadaveric elbows using the triceps-on or triceps-off approach. The bones were dissected out and the position of the implants measured relative to anatomical landmarks. The flexion/extension and varus/valgus angles, and the distance of centre of rotation from the anatomic centre of rotation in the sagittal plane for both components were obtained as well as the humeral component rotation relative to the transepicondylar axis. Results All humeral components were positioned in external rotation and all ulna components were placed in flexion. Seven components were positioned greater than 5° away from the ideal in one measurement, with no significant difference between the two approach groups. Discussion This unique study showed no significant difference in the alignment of the implants between the two approaches. These results support the theory that the triceps-on approach does not result in larger alignment errors in component positioning when performing total elbow arthroplasty.

Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty

2020 ◽  
pp. 175857322093623
Author(s):  
Georges Haidamous ◽  
Alexandre Lädermann ◽  
Robert U Hartzler ◽  
Bradford O Parsons ◽  
Evan S Lederman ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Level Of Evidence ◽  
Component Size ◽  
Excellent Outcome ◽  
Forward Flexion ◽  
Humeral Component ◽  
Radiographic Measurements

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.

The influence of reverse arthroplasty humeral component design features on scapular spine strain

2020 ◽  
Author(s):  
Alicia M. Kerrigan ◽  
Jacob M. Reeves ◽  
G. Daniel G. Langohr ◽  
James A. Johnson ◽  
George S. Athwal
Keyword(s):  
Design Features ◽  
Humeral Component ◽  
Component Design ◽  
Scapular Spine ◽  
Reverse Arthroplasty

scholarly journals Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty

2021 ◽  
Vol 5 ◽  
pp. 247154922110233
Author(s):  
Helen Razmjou ◽  
Varda van Osnabrugge ◽  
Mark Anunciacion ◽  
Andrea Nunn ◽  
Darren Drosdowech ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Current Evidence ◽  
Serratus Anterior ◽  
Upper Trapezius ◽  
Reverse Arthroplasty ◽  
Scapular Plane ◽  
Teres Minor

Purpose The purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence. Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications. Results In light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position. Conclusion Improving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.

scholarly journals Medialized versus Lateralized Center of Rotation in Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (24) ◽  
pp. 5868
Author(s):  
Alessandra Berton ◽  
Lawrence Vicent Gulotta ◽  
Umile Giuseppe Longo ◽  
Sergio De Salvatore ◽  
Ilaria Piergentili ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Cochrane Central Register ◽  
Complication Rates ◽  
Center Of Rotation ◽  
Humeral Component ◽  
Reverse Total Shoulder

One of the original biomechanical principles of reverse total shoulder arthroplasty (RTSA) is medialization of the center of rotation (COR) relative to the native level of the glenoid. Several authors have proposed the lateralized center of rotation, which is characterized by a lateralized (L) glenoid and medialized (M) humeral component. The aim of this review is to compare the clinical and functional outcomes of COR in medialized (M-RTSA) and lateralized (L-RTSA) RTSA in patients with uniform indications and treatment through a meta-analysis. A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cochrane Clinical Answers was conducted from April to May 2021. Twenty-four studies were included in the qualitative synthesis, and 19 studies were included in the meta-analysis. Treatment with RTSA resulted in positive post-operative outcomes and low complication rates for both groups. Statistically relevant differences between L-RTSA group and M-RTSA group were found in post-operative improvement in external rotation with arm-at-side (20.4° and 8.3°, respectively), scapular notching rates (6.6% and 47.7%) and post-operative infection rates (1% and 7.7%). Both lateralized and medialized designs were shown to improve the postoperative outcomes. Nevertheless, a lateralized COR resulted in greater post-operative external rotation.

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