Combined effect of change in humeral neck-shaft angle and retroversion on shoulder range of motion in reverse total shoulder arthroplasty — A simulation study

Background Deltoid muscle function is paramount to the success of reverse total shoulder arthroplasty. The purpose of this study was to investigate the role of deltoid volume on shoulder range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions. Methods Retrospective review of records identified 107 patients who met inclusion criteria. The rotator cuff integrity was evaluated by two musculoskeletal-trained radiologists. Volumetric deltoid measurements were calculated from preoperative computed tomography or magnetic resonance imaging scans. Satisfactory outcomes were defined as forward elevation of at least 135°, external rotation of at least 35°, and American Shoulder and Elbow Surgeons and Single Assessment Numerical Evaluation scores of at least 70. Results Mean total deltoid muscle volume was significantly higher in patients with satisfactory forward elevation (57.8 ± 18.1 cm³) versus unsatisfactory forward elevation (48.6 ± 19.5 cm³) (p = 0.013). When separated by rotator cuff integrity, total deltoid volume was significantly higher (p = 0.030) in patients who achieved satisfactory forward elevation in the rotator cuff-deficient group but not the rotator cuff-intact group (p = 0.533). Discussion Preoperative deltoid volume directly correlated with achieving satisfactory forward elevation after reverse total shoulder arthroplasty in rotator cuff-deficient conditions and may be one factor in determining the ability to achieve satisfactory outcomes in the rotator cuff-deficient patient.

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An update on reverse total shoulder arthroplasty: current indications, new designs, same old problems

EFORT Open Reviews ◽

10.1302/2058-5241.6.200085 ◽

2021 ◽

Vol 6 (3) ◽

pp. 189-201

Author(s):

Thomas Kozak ◽

Stefan Bauer ◽

Gilles Walch ◽

Saad Al-karawi ◽

William Blakeney

Keyword(s):

Shoulder Arthroplasty ◽

Mixed Reality ◽

Total Shoulder Arthroplasty ◽

Computer Navigation ◽

Reverse Total Shoulder Arthroplasty ◽

Patient Specific ◽

Shoulder Replacement ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Reverse Total Shoulder

Reverse total shoulder arthroplasty (RTSA) was originally developed because of unsatisfactory results with anatomic shoulder arthroplasty options for the majority of degenerative shoulder conditions and fractures. After initial concerns about RTSA longevity, indications were extended to primary osteoarthritis with glenoid deficiency, massive cuff tears in younger patients, fracture, tumour and failed anatomic total shoulder replacement. Traditional RTSA by Grammont has undergone a number of iterations such as glenoid lateralization, reduced neck-shaft angle, modular, stemless components and onlay systems. The incidence of complications such as dislocation, notching and acromial fractures has also evolved. Computer navigation, 3D planning and patient-specific implantation have been in use for several years and mixed-reality guided implantation is currently being trialled. Controversies in RTSA include lateralization, stemless humeral components, subscapularis repair and treatment of acromial fractures. Cite this article: EFORT Open Rev 2021;6:189-201. DOI: 10.1302/2058-5241.6.200085

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Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2013.11.003 ◽

2014 ◽

Vol 23 (8) ◽

pp. 1091-1098 ◽

Cited By ~ 61

Author(s):

Joo Han Oh ◽

Sang-Jin Shin ◽

Michelle H. McGarry ◽

Jonathan H. Scott ◽

Nathanael Heckmann ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Reverse Total Shoulder

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Biomechanical Differences in Reverse Total Shoulder Arthroplasty According to the Humeral Neck-Shaft Angle

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2012.12.042 ◽

2013 ◽

Vol 22 (4) ◽

pp. e37-e38 ◽

Cited By ~ 1

Author(s):

Joo Han Oh ◽

Sang Jin Sin ◽

Seok Won Chung ◽

Michelle H. McGarry ◽

Jonathan Scott ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Reverse Total Shoulder

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Anatomic total shoulder arthroplasty in rheumatoid arthritis: A systematic review

Shoulder & Elbow ◽

10.1177/1758573220954157 ◽

2020 ◽

pp. 175857322095415

Author(s):

Ahmed Haleem ◽

Ajaykumar Shanmugaraj ◽

Nolan S. Horner ◽

Timothy Leroux ◽

Moin Khan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Range Of Motion ◽

Shoulder Arthroplasty ◽

Constant Score ◽

Total Shoulder Arthroplasty ◽

Significant Heterogeneity ◽

Tissue Quality ◽

Patient Reported ◽

Clinically Significant ◽

Reverse Total Shoulder

Purpose Given the poor soft-tissue quality in rheumatoid arthritis patients, many believe that rheumatoid arthritis should be treated with reverse total shoulder arthroplasty (rTSA). The purpose of this paper is to systematically assess outcomes of anatomic total shoulder arthroplasty (aTSA) in rheumatoid arthritis to determine if aTSA remains a viable option. Methods A comprehensive literature search was conducted identifying articles relevant to aTSA in the setting of rheumatoid arthritis with intact rotator cuff. Outcomes include clinical outcomes and rates of complication and revision. Results Ten studies were included with a total of 279 shoulders with mean follow-up of 116 ± 69 months. The mean age was 68 ± 10 years. Survivorship was 97%, 97% and 89% at 5, 10 and 20 years, respectively. The overall complication rate was 9%. Radiolucency was present in 69% of patients, of which 34% were at risk of loosening at 79 months. The overall rate of revision was 8.4%. Studies generally reported clinically significant improvements in range of motion, Constant score and ASES score. Conclusion aTSA in the rheumatoid patient results in improvements in range of motion and patient-reported outcomes. Rates of complications and survivorship are generally good in this population. However, it should be noted that there is significant heterogeneity in outcome reporting amongst the literature on this topic and that many studies fail to adequately report complication and revision rates. When compared to rTSA in patients with rheumatoid arthritis, evidence suggests that aTSA is still a viable treatment option despite the shift in utilization to rTSA.

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Influence of Humeral Version and Deltoid Tension on Glenohumeral Kinematics After Reverse Total Shoulder Arthroplasty

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53323 ◽

2011 ◽

Author(s):

Heath B. Henninger ◽

Alexej Barg ◽

Robert Z. Tashjian ◽

Robert T. Burks ◽

Kent N. Bachus ◽

...

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Outcome Measures ◽

Shoulder Arthroplasty ◽

Surgical Intervention ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

And Function ◽

Reverse Total Shoulder

Reverse total shoulder arthroplasty (rTSA) is used to improve pain and function in arthritic, rotator cuff deficient shoulders. Surgical intervention is considered successful if range of motion and stability of the joint is maximized and force to abduct the arm is minimized. Implant hardware positioning may affect these outcome measures.

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Radiographic and clinical outcomes of second generation Trabecular Metal™ glenoid components in total shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/1758573220909981 ◽

2020 ◽

pp. 175857322090998

Author(s):

Raymond E Chen ◽

Alexander M Brown ◽

Alexander S Greenstein ◽

Sandeep Mannava ◽

Ilya Voloshin

Keyword(s):

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Second Generation ◽

Total Shoulder Arthroplasty ◽

Implant Survival ◽

Trabecular Metal ◽

Metal Debris ◽

Shoulder Range Of Motion ◽

Shoulder Range

Background Total shoulder arthroplasty with second generation porous tantalum glenoid implants (Trabecular Metal™) has shown good short-term outcomes, but mid-term outcomes are unknown. This study describes the clinical, radiographic, and patient-rated mid-term outcomes of total shoulder arthroplasty utilizing cemented Trabecular Metal™ glenoid components. Methods Patients who underwent anatomic total shoulder arthroplasty with cemented Trabecular Metal™ glenoid components for primary osteoarthritis were identified for minimum five-year follow-up. The primary outcome measure was implant survival; secondary outcome measures included patient-rated outcome scores, shoulder range of motion findings, and radiographic analysis. Results Twenty-seven patients were enrolled in the study. Twenty-one patients had full radiographic follow-up. Mean follow-up was 6.6 years. There was 100% implant survival. Shoulder range of motion significantly improved and the mean American Shoulder and Elbow Society score was 89.8. There was presence of metal debris radiographically in 24% of patients. Twenty-nine percent of patients had evidence of radiolucency. Fourteen percent of patients had moderate superior subluxation. Conclusion Total shoulder arthroplasty with second generation cemented Trabecular Metal™ glenoid components yielded good outcomes at mean 6.6-year follow-up. Metal debris incidence and clinical outcomes were similar to short-term findings. The presence of metal debris did not significantly affect clinical outcomes. Continued observation of these patients will elucidate longer-term implant survival.

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Does Humeral Component Version Affect Range of Motion and Clinical Outcomes in Reverse Total Shoulder Arthroplasty? A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10245745 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5745

Author(s):

Shivan S. Jassim ◽

Lukas Ernstbrunner ◽

Eugene T. Ek

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Cochrane Library ◽

Functional Scores ◽

Outcome Scores ◽

Reverse Total Shoulder

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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