Reverse total shoulder arthroplasty clinical and patient-reported outcomes and complications stratified by pre-operative diagnosis: a systematic review

2020 ◽  
Author(s):  
June Kennedy ◽  
Christopher S. Klifto ◽  
Leila Ledbetter ◽  
Garrett S. Bullock
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Patient Reported ◽  
Reverse Total Shoulder

Reverse total shoulder arthroplasty

2021 ◽  
pp. 1-9
Author(s):  
Eleanor G. Burden ◽  
Timothy J. Batten ◽  
Christopher D. Smith ◽  
Jonathan P. Evans
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Implant Design ◽  
Complication Rates ◽  
Scapular Notching ◽  
Cuff Tear ◽  
Patient Reported ◽  
Reverse Total Shoulder

Aims This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). Methods A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). Results A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies. Conclusion This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design.

scholarly journals Resilience Correlates with Patient Reported Outcomes after Reverse Total Shoulder Arthroplasty

2020 ◽  
pp. 102777
Author(s):  
Alex R Dombrowsky ◽  
Graham Kirchner ◽  
Jonathan Isbell ◽  
Eugene W Brabston ◽  
Brent A Ponce ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Patient Reported ◽  
Reverse Total Shoulder

Effect of deltoid volume on range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions

2020 ◽  
pp. 175857322092504
Author(s):  
Samuel G McClatchy ◽  
Griffin M Heise ◽  
William M Mihalko ◽  
Frederick M Azar ◽  
Richard A Smith ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Deltoid Muscle ◽  
Reverse Total Shoulder Arthroplasty ◽  
Shoulder Range Of Motion ◽  
Patient Reported ◽  
Reverse Total Shoulder

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.

Reassessing glenoid inclination in reverse total shoulder arthroplasty with glenosphere lateralization

2021 ◽  
Vol 103-B (2) ◽  
pp. 360-365
Author(s):  
Kuhan A. Mahendraraj ◽  
Maggie V. Shields ◽  
Florian Grubhofer ◽  
Samuel W. Golenbock ◽  
Andrew Jawa
Keyword(s):  
Heterotopic Ossification ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Patient Reported ◽  
Reverse Total Shoulder

Aims Existing literature indicates that inferiorly inclined glenoid baseplates following reverse total shoulder arthroplasty (RSA) produce better outcomes compared to superiorly inclined baseplates. We aim to compare clinical outcomes for RSAs with superiorly and neutrally/inferiorly inclined lateralized glenospheres. Methods We retrospectively reviewed 154 consecutive patients undergoing RSA between July 2015 and July 2017 by one single-fellowship trained surgeon (AJ). Two raters (KAM and MVS) independently measured glenoid inclination in preoperative and minimum two year follow-up radiographs (anteroposterior/Grashey) using the RSA angle. Inclination was then compared to patient-reported outcomes, range of motion (ROM), and independently assessed degree of scapular notching and staging of heterotopic ossification at two year follow-up. Results Median postoperative inclination for each group was found to be -3.6° (interquartile range (IQR) -2.1 to -6.9) and 6.0° (3.2° to 10.1°) for the neutrally/inferiorly and superiorly inclined cohorts, respectively. Preoperative inclination was highly associated with postoperative inclination (p = 0.004). When comparing superiorly and neutrally/inferiorly inclined glenospheres, there were no differences in heterotopic ossification (p = 0.606), scapular notching (p = 0.367), American Shoulder and Elbow Surgeons score (p = 0.419), Single Assessment Numeric Evaluation (p = 0.417), Visual Analogue Scale (VAS) pain score (p = 0.290), forward elevation (p = 0.161), external rotation (p = 0.537), or internal rotation (p = 0.656). Conclusion Compared to neutral and inferior inclination, up to 6° ± 3° of superior glenoid baseplate inclination on a lateralized RSA design produces no differences in postoperative ROM or patient-reported outcomes, and produces similar levels of scapular notching and heterotopic ossification. Additionally, the degree of preoperative inclination represents an important factor in surgical decision-making as it is strongly associated with postoperative inclination. It is important to note that the findings of this study are only reflective of lateralized RSA prostheses. Cite this article: Bone Joint J 2021;103-B(2):360–365.

A randomised trial comparing two rehabilitation approaches following reverse total shoulder arthroplasty

2020 ◽  
pp. 175857322093739
Author(s):  
Peter K Edwards ◽  
Jay R Ebert ◽  
Brendan Joss ◽  
Timothy Ackland ◽  
Allan Wang
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Active Group ◽  
Objective Measures ◽  
Post Surgery ◽  
Patient Reported ◽  
Active Rehabilitation ◽  
Reverse Total Shoulder

Background Rehabilitation contributes to post-operative success following reverse total shoulder arthroplasty; however, randomised trials comparing the effectiveness of rehabilitation following reverse total shoulder arthroplasty are lacking. This study sought to determine if early, active mobilisation targeting the deltoid and the external rotator muscles, would exhibit greater improvements in post-operative outcomes compared to a delayed and deltoid-focused mobilisation programme. Methods Patients scheduled for reverse total shoulder arthroplasty were randomly assigned to either an early active or delayed active rehabilitation group. Patient-reported outcomes for pain and function were assessed pre-surgery and at 3, 6 and 12 months post-surgery. Objective measures (Constant Score, range of motion, isometric strength) were assessed at 3, 6 and 12 months post-surgery. Results Sixty-one patients (63 shoulders) underwent reverse total shoulder arthroplasty. There were no significant interaction effects or between-group differences for any patient-reported outcomes or objective measures at 3, 6 or 12 months post-surgery. However, significantly better ( p = 0.019) active arm flexion was observed in the early active group at three months post-surgery. Significantly more patients in the early active group reported improvement in patient-reported function that reached minimal clinically important difference from three to six months post-surgery ( p = 0.016). Conclusion Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme. Level of evidence Therapy, level 1b. Trial registered 15 June 2016 at www.anzctr.org.au (ACTRN12616000779471).

Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review

2021 ◽  
pp. 175857322110193
Author(s):  
Arjun K Reddy ◽  
Jake X Checketts ◽  
B Joshua Stephens ◽  
J Michael Anderson ◽  
Craig M Cooper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Revisional Surgery ◽  
Total Shoulder Arthroplasty ◽  
Surgical Site Infections ◽  
Total Sample ◽  
Reverse Total Shoulder Arthroplasty ◽  
Common Complication ◽  
Humeral Component ◽  
Reverse Total Shoulder

Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

scholarly journals Shoulder Strength Outcomes Following Reverse Total Shoulder Arthroplasty: A Systematic Review and Descriptive Synthesis

2021 ◽  
Author(s):  
Fletcher R. Preuss ◽  
Stephanie K. Eble ◽  
Annalise M. Peebles ◽  
Antonia Osuna-Garcia ◽  
CAPT. Matthew T. Provencher
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Shoulder Strength ◽  
Reverse Total Shoulder
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