scholarly journals Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching

2020 ◽  
Vol 15 (3) ◽  
pp. 207-212
Author(s):  
Patric Raiss ◽  
Rainer Neumann
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Scapular Notching ◽  
Neck Shaft Angle ◽  
Shoulder Flexion

Abstract Introduction Reverse shoulder arthroplasty (RSA) has become a well-established treatment option for multiple disorders of the shoulder joint. In recent years, implant designs and configurations have been modified in order to improve function and avoid complications. Lateralization on the glenoid and the humeral side has been described to improve function and decrease radiographic scapular notching. Data on the clinical and radiographic results of bipolar lateralization in RSA are lacking. Methods In 38 cases, RSA was performed using an uncemented humeral short-stem component with a 145° neck–shaft angle in combination with bone lateralization on the glenoid side (Bony Increased-Offset Reversed Shoulder Arthroplasty, BIO-RSA; Wright Medical Inc., Memphis, TN, USA). Mean follow-up was 19 months (range 12–34 months). Patients were followed clinically using the Constant score as well as range of motion for shoulder flexion and external rotation. Radiographs in two different plains were analyzed for implant seating and the occurrence of scapular notching. Results There was a significant increase in all measured clinical parameters. Forward flexion increased from a mean of 75° preoperatively to 151° postoperatively, and mean Constant score increased from 21 to 71 points postoperatively (p < 0.001). Glenoid notching of grade 1 according to Sirveuax was observed in 3 out of 35 cases (9%); no grade 2, 3, or 4 notching was present. Revision surgery was necessary in one case (3%). Conclusion RSA with bipolar lateralization leads to excellent clinical outcomes, low complication rates, and low rates of radiographic scapular notching. Longer follow-up and prospective randomized trials are needed. Level of evidence Level IV.

scholarly journals Is limited external rotation after reverse shoulder arthroplasty associated with glenoidal notching?

2021 ◽  
Author(s):  
Alexandra Grob ◽  
Samy Bouaicha ◽  
Marco Germann ◽  
Sabra Germann ◽  
Christian Gerber ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Radiographic Progression ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Cuff Tear ◽  
Over Time

Abstract Background Reverse shoulder arthroplasty (RSA) is a valuable solution for patients with shoulder pain or injury primarily due to a rotator cuff tear or secondary to traumatic events. Nevertheless, several complications are known to appear, with the most frequent being scapular notching (SN) on the inferior and posterior scapular neck. Controversial data exist about the clinical relevance of SN. Since further consequences are still not clearly understood, we aimed to provide more clarity on which factors, especially external rotation (ER), contribute to the appearance and progress of notching. Methods Constant Score (CS), Subjective Shoulder Value (SSV), flexion, abduction, and ER were evaluated retrospectively in 153 shoulders of 147 patients (mean age 79±7.7 years; 62% women) who underwent RSA between 2005 and 2010. Anteroposterior radiographs were evaluated before and 1, 2, 3, and 5 years after RSA for SN according to the Sirveaux classification. The evaluation was performed by two independent surgeons. Spearman’s coefficient and t-test were used. Results CS, SSV, flexion, and abduction increased significantly 1 year after RSA compared to before (all p < 0.0001). No improvement was shown for ER between the same timepoints. Between 2 and 5 years of follow-up, only flexion decreased by 5°(p = 0.02) while CS, SSV, abduction, and ER remained constant. After RSA, notching increases over time. There was no association between SN and CS, SSV, flexion, abduction or ER at any of the measured timepoints. Higher flexion correlated with higher abduction after RSA at every follow-up (1 year r = 0.88, 2 years r = 0.89, 3 years r = 0.86, 5 years r = 0.86). The interrater correlation test showed a strong correlation (r = 0.7). Conclusion We verified the functional benefits of RSA for patients. Additionally, our findings show that despite radiographic progression of notching and unchanged limited ER, the postoperative improvements in CS, SSV, flexion, and abduction are preserved over 5 years.

scholarly journals Can Lateralization of Reverse Shoulder Arthroplasty Improve Active External Rotation in Patients with Preoperative Fatty Infiltration of the Infraspinatus and Teres Minor?

2021 ◽  
Vol 10 (18) ◽  
pp. 4130
Author(s):  
Marko Nabergoj ◽  
Shinzo Onishi ◽  
Alexandre Lädermann ◽  
Houssam Kalache ◽  
Rihard Trebše ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Fatty Infiltration ◽  
Postoperative Recovery ◽  
Neck Shaft Angle ◽  
Shaft Angle ◽  
Teres Minor

(1) Background: Postoperative recovery of external rotation after reverse shoulder arthroplasty (RSA) has been reported despite nonfunctional external rotator muscles. Thus, this study aimed to clinically determine the ideal prosthetic design allowing external rotation recovery in such a cohort. (2) Methods: A monocentric comparative study was retrospectively performed on patients who had primary RSA between June 2013 and February 2018 with a significant preoperative fatty infiltration of the infraspinatus and teres minor. Two groups were formed with patients with a lateral humerus/lateral glenoid 145° onlay RSA—the onlay group (OG), and a medial humerus/lateral glenoid 155° inlay RSA—the inlay group (IG). Patients were matched 1:1 by age, gender, indication, preoperative range of motion (ROM), and Constant score. The ROM and Constant scores were assessed preoperatively and at a minimum follow-up of two years. (3) Results: Forty-seven patients have been included (23 in OG and 24 in IG). Postoperative external rotation increased significantly in the OG only (p = 0.049), and its postoperative value was significantly greater than that of the IG by 11.1° (p = 0.028). (4) Conclusion: The use of a lateralized humeral stem with a low neck-shaft angle resulted in significantly improved external rotation compared to a medialized humeral 155° stem, even in cases of severe fatty infiltration of the infraspinatus and teres minor. Humeral lateralization and a low neck-shaft angle should be favored when planning an RSA in a patient without a functional posterior rotator cuff.

scholarly journals Glenoid loosening and migration in reverse shoulder arthroplasty

2019 ◽  
Vol 101-B (4) ◽  
pp. 461-469 ◽  
Author(s):  
A. Lädermann ◽  
A. J. Schwitzguebel ◽  
T. B. Edwards ◽  
A. Godeneche ◽  
L. Favard ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Multivariable Analysis ◽  
Range Of Movement ◽  
Original Cohort ◽  
Glenoid Loosening

Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.

scholarly journals Onlay Uncemented Lateralized Reverse Shoulder Arthroplasty for Fracture Sequelae Type 1 with Valgus/Varus Malunion: Deltoid Lengthening and Outcomes

2020 ◽  
Vol 9 (10) ◽  
pp. 3190
Author(s):  
Alfonso Maria Romano ◽  
Adriano Braile ◽  
Pasquale Casillo ◽  
Guglielmo Nastrucci ◽  
Massimiliano Susanna ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Varus Deformity ◽  
Proximal Part ◽  
Fracture Sequelae ◽  
Cemented Stem ◽  
The Mean

The successful treatment of proximal humeral fractures remains challenging for shoulder surgeons, and failure rates are high, regardless of initial treatment. This study aimed to analyze the clinical and radiographic midterm results of onlay lateralized cementless stem reverse shoulder arthroplasty (RSA) in patients with valgus/varus malunion proximal humerus fracture sequelae without metaphyseal osteotomy. We retrospectively studied 35 cases with the diagnosis of fracture sequelae of the proximal part of the humerus with valgus/varus malunion. The mean duration of follow-up was 4.6 years (range, 2 to 7 years), and the mean time between fracture and arthroplasty was 6 years (1 to 32 years). Seventeen patients (48.6%) had initially been treated nonoperatively. The Constant score (CS), active range of motion, and radiographs of the affected shoulders, as well as the acromion to greater tuberosity (AGT) distance and deltoid length (DL), were analyzed before surgery and at their latest follow-up. A total of thirty-three patients (94.3%) rated their outcome as very good or good. Mean CS, forward flexion, and external rotation improved significantly (p < 0.0001), as did internal rotation and pain (p < 0.05). AGT distance significantly increased postoperatively from 14.7 to 43.3 mm, as did DL from 143 to 170 mm (p < 0.05). There was no correlation between the outcomes and valgus/varus deformity, previous surgeries, or AGT distance/DL. A total of four complications occurred (11.4%): two dislocations were detected (5.7%) and successfully revised with a longer cemented stem. Onlay lateralized uncemented stem RSA improves clinical outcomes and decreases complications when treating valgus/varus malunion fracture sequelae, avoiding intraoperative technical challenges, such as tuberosities osteotomy conscious of bone loss and proper deltoid tensioning.

scholarly journals Reverse shoulder arthroplasty in complex fractures of the proximal humerus: results after 7 years of follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alberto Izquierdo-Fernández ◽  
Marta Gómez-Rodríguez ◽  
Maite Urbano-Luque ◽  
Manuel García-Carmona ◽  
Rafael Quevedo-Reinoso ◽  
...  
Keyword(s):  
Cohort Study ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Long Term Results ◽  
First Year ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Scapular Notching

Abstract Background There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. Material and methods A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. Results After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. Conclusions At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. Level of evidence III Controlled cohort study.

scholarly journals Reverse shoulder arthroplasty-early results

2021 ◽  
Vol 38 (3) ◽  
pp. 216-220
Author(s):  
Ferhat SAY ◽  
Numan KUYUBAŞI ◽  
Ahmet PİŞKİN ◽  
Murat BÜLBÜL
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Proximal Humerus ◽  
External Rotation ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Fracture Group ◽  
Scapular Notching ◽  
Early Results ◽  
Rotator Cuff Arthropathy

Although reverse shoulder arthroplasty is used in massive rotator cuff tears, it is also used in proximal humerus fractures and shoulder arthroplasty revision. In this study, we aimed to examine the early radiological and clinical results of patients undergoing reverse shoulder arthroplasty with different diagnoses. Between 2010 and 2013, reverse shoulder arthroplasty was applied to 10 patients (4 men, 6 women) with the diagnosis of arthropathy due to rotator cuff tear (n: 7), multi-fragmentary proximal humerus fracture (n: 2) and hemiarthroplasty revision (n: 1). The median age of the patients was 74 (64-85) years and the median follow-up was 15.5 (3-35) months. Patients were assessed in terms of joint range of motion, Constant score and Visual Pain Scale (VAS) and radiological examinations before and after surgery. Preoperative active shoulder flexion, abduction, internal and external rotation degrees of the patients were 65, 30, 40 and 50 degrees, and 105, 95, 30, 57.5 degrees respectively in their final controls. Constant score was 20.5 (14-63) preoperatively, and 54.5 (38-64) in the final controls (p˂0.05). While the preoperative VAS was 7 (3-9), it was found to be 1.5 (1-3) in the final controls (p˂0.05). As a complication, scapular notching was observed in one patient. Internal external rotation values were better in the rotator cuff arthropathy group than the fracture group. Reverse shoulder arthroplasty, especially in the treatment of patients with rotator cuff arthropathy, has good early results and a low complication rate. We recommend paying attention to the glenoid component location to avoid scapular notching.

Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison

2020 ◽  
pp. 175857322092115
Author(s):  
Bradley S Schoch ◽  
Joseph J King ◽  
Joseph Zuckerman ◽  
Thomas W Wright ◽  
Chris Roche ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reoperation Rate ◽  
Patient Reported ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty

2018 ◽  
Vol 100-B (9) ◽  
pp. 1182-1186 ◽  
Author(s):  
B. S. Werner ◽  
J. Chaoui ◽  
G. Walch
Keyword(s):  
Internal Rotation ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Large Diameter ◽  
Glenoid Component ◽  
Range Of Movement ◽  
Scapular Notching ◽  
Component Size ◽  
Centre Of Rotation

Aims Scapular notching is a frequently observed radiographic phenomenon in reverse shoulder arthroplasty (RSA), signifying impingement of components. The purposes of this study were to evaluate the effect of glenoid component size and glenosphere type on impingement-free range of movement (ROM) for extension and internal and external rotation in a virtual RSA model, and to determine the optimal configuration to reduce the incidence of friction-type scapular notching. Materials and Methods Preoperative CT scans obtained in 21 patients (three male, 18 female) with primary osteoarthritis were analyzed using modelling software. Two concurrent factors were tested for impingement-free ROM and translation of the centre of rotation: glenosphere diameter (36 mm vs 39 mm) and type (centred, 2 mm inferior eccentric offset, 10° inferior tilt). Results Glenosphere size was most predictive of increased extension and external rotation, whereas lateralization of the centre of rotation was the most predictive factor for internal rotation. A larger diameter of glenosphere combined with a 10° tilted configuration demonstrated superior values for extension and external rotation, whereas the eccentric component improved internal rotation by a mean 8.9° (standard deviation 2.7°) compared with a standard concentric glenosphere. Conclusion Glenosphere configuration can be modified to increase range of movement in RSA. Friction-type scapular notching was most effectively reduced by use of a large-diameter glenosphere with 10° inferior tilt. Cite this article: Bone Joint J 2018;100-B:1182–6.

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