Early restoration of shoulder function in patients with the Grammont prosthesis compared to lateralized humeral design in reverse shoulder arthroplasty

Abstract Background Prosthetic replacement of the proximal humerus with reverse shoulder arthroplasty (RSA) is an established means of treatment. Due to its unique biomechanical characteristics, RSA can restore shoulder function to a satisfying level in the case of cuff tear arthropathy, arthritis, and fractures. However, complications are frequent in RSA, one of the more common being implant instability with dislocation. The present study investigated the influence of glenosphere diameter and metaglene lateralization using a unique test setup. Methods Seven fresh-frozen cadaveric specimens of the shoulder were thawed and dissected. The subscapularis muscle, the infraspinatus, and the three heads of the deltoid muscle were fixed to a pulley system. After implanting an RSA in different configurations (38/42 mm glenosphere with lateralization of +0 mm, +5 mm, or +10 mm), the implants were dislocated using selective muscle pull. The frequency of dislocations depending on the prosthesis configuration was documented. Results The larger glenosphere diameter of 42 mm showed less dislocations than the diameter of 38 mm (39 vs. 46). Lateralization of +0, +5 mm, and +10 mm showed 26, 29, and 30, dislocations, respectively. Dislocation via pull on the infraspinatus muscle was most frequent. None of the results reached statistical significance. Conclusion The current investigation used a novel technique for investigating the effect of lateralization and glenosphere diameter on RSA instability. Despite indicating tendencies, the present test setup could not prove the hypothesis that a larger glenosphere diameter and increased lateralization add to stability. The lack of statistical significance could be attributable to the low specimen number. The clinical significance of lateralization and glenosphere diameter should be further assessed in future biomechanical investigations.

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TOTAL SHOULDER ARTHROPLASTY, AN OVERVIEW, INDICATINS AND PROSTHETIC OPTIONS

Wiadomości Lekarskie ◽

10.36740/wlek202009112 ◽

2020 ◽

Vol 73 (9) ◽

pp. 1870-1873

Author(s):

Mateusz Wicha ◽

Agnieszka Tomczyk-Warunek ◽

Jaromir Jarecki ◽

Anna Dubiel

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Shoulder Function ◽

Long Term Result ◽

Glenohumeral Osteoarthritis ◽

Hip Arthroplasties ◽

Reverse Total Shoulder

Shoulder arthroplasty (SA) has improved significantly over the last twenty years. It offers the effective treatment for patients with severe shoulder dysfunctions. The indications for this procedure have recently expanded tremendously. However, the most common are glenohumeral osteoarthritis, inflammatory shoulder arthropathies, rotator cuff-tear arthropathy, complex fractures of the proximal humerus and osteonecrosis of a humeral head. There is range of the procedures, such as resurfacing of humeral head, anatomic total shoulder arthroplasty, hemiarthroplasty and reverse shoulder arthroplasty. All of them could significantly improve patients quality of life. The outcomes of the shoulder arthroplasty are very satisfying in terms of pain relief and considerable improvements in shoulder function as well as in motion. However, this procedure is not so popular as knee or hip arthroplasties. The reasons for this phenomenon are not clear. The complication rate is considerably low. The most common are periprosthetic fractures, infections, implant loosening and instability. The reasonable solution is a conversion to reverse total shoulder arthroplasty. The survivorship of the prosthesis is up to 12 years, which is acceptable by patients. Long term result are still not clear. Surgeons performing SA opt for deltopectoral approach which provides good exposure of the joint also for revisions. The aim: To summarize knowledge about SA based on current literature.

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Pre-Operative CT-Based Planning Integrated With Intra-Operative Navigation in Reverse Shoulder Arthroplasty: Data Acquisition and Analysis Protocol, and Preliminary Results of Navigated Versus Conventional Surgery

Dose-Response ◽

10.1177/1559325820970832 ◽

2020 ◽

Vol 18 (4) ◽

pp. 155932582097083

Author(s):

Fabio Moreschini ◽

Giovanni Battista Colasanti ◽

Carlo Cataldi ◽

Lorenzo Mannelli ◽

Nicola Mondanelli ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Conventional Technique ◽

Shoulder Function ◽

Glenoid Component ◽

Navigation Group ◽

Screw Length ◽

Operative Planning ◽

Glenoid Baseplate

Reverse total shoulder arthroplasty (RSA) successfully restores shoulder function in different conditions. Glenoid baseplate fixation and positioning seem to be the most important factors influencing RSA survival. When scapular anatomy is distorted (eccentric osteoarthrirtis, rotator cuff arthropathy), optimal baseplate positioning and secure screw purchase can be challenging. The aim of this study was to evaluate whether CT-based pre-operative planning, integrated with intra-operative navigation could improve glenoid baseplate fixation and positioning by increasing screw length, reducing number of screws required to obtain fixation and increasing the use of augmented baseplate to gain the desired positioning. Twenty patients who underwent navigated RSA were compared retrospectively with 20 patients operated on with a conventional technique. All the procedures were performed by the same surgeon, using the same implant. Mean screw length was significantly longer in the navigation group (35.5 ± 4.4 mm vs 29.9 ± 3.6 mm; p = .001). Significant higher rate of optimal fixation using 2 screws only (17 vs 3 cases, p = .019) and higher rate of augmented baseplate usage (13 vs 4 cases, p = .009) was also present in the navigation group. Pre-operative CT-based planning integrated with intra-operative navigation can improve glenoid component positioning and fixation, possibly leading to an improvement of RSA survival.

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Sonographic assessment of the subscapularis after reverse shoulder arthroplasty: impact of tendon integrity on shoulder function

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.12.008 ◽

2018 ◽

Vol 27 (6) ◽

pp. 1051-1056 ◽

Cited By ~ 13

Author(s):

Nicolas J. Dedy ◽

Conor J. Gouk ◽

Fraser J. Taylor ◽

Michael Thomas ◽

S.L. Ezekiel Tan

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Shoulder Function ◽

Sonographic Assessment

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Study on glenoid component in anatomical total shoulder arthroplasty in Nagapattinam district

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210497 ◽

2021 ◽

Vol 7 (2) ◽

pp. 223

Author(s):

A. Palanivel

Keyword(s):

Outcome Measures ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Randomized Study ◽

Shoulder Function ◽

Glenoid Component ◽

Screw Breakage ◽

Pain At Rest

Background: Depending upon the mechanism of dysfunction or injury a shoulder arthroplasty can either be a partial or total replacement. Shoulder arthroplasty surgery has shown remarkable progress during the last few decades. The objective was to study the effect of prosthesis positioning in reverse shoulder arthroplasty on radiological and clinical outcomes.Methods: This was a prospective comparative non-randomized study of 37 patients who underwent reverse shoulder arthroplasty (RSA) in Government District Head Quarters Hospital Nagapattinam with a follow-up ranging from March 2018 to January 2019 (11 months).Results: Grade 1 indicated a notch limited to the scapular pillar, grade 2 reached the inferior screw of the baseplate, grade 3 extended beyond the inferior screw and grade 4 reached the central peg of the baseplate. Glenoid loosening was defined as radiolucencies under the baseplate or around the peg or screws, screw breakage, or glenoid migration.Conclusions: Outcome measures were improved regardless of the LHO. At 3 months follow-up increased LHO harmed shoulder function and gave more shoulder pain at rest and exertion but did not affect the quality of life, health status, or ROM. At 12 months follow-up, LHO had no relation with the outcome measures. Further studies are warranted to investigate the influence of LHO on long-term prosthetic survival.

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