Effect of Critical Shoulder Angle, Glenoid Lateralization and Humeral Inclination on Range of Motion in Reverse Shoulder Arthroplasty

Objectives To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies. Methods 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction. Results CSA did not seem to influence ROM in any of the models, but greater lateralization achieved greater ROM for all movements in all configurations. Internal and external rotation at 90° of abduction were impossible in most configurations, except in models with a CSA of 25°. Conclusion Postoperative ROM following RSA depends on multiple patient and surgical factors. This study, based on computer simulation, suggests that CSA has no influence on ROM after RSA, while lateralization increases ROM in all configurations. Furthermore, increasing subacromial space is important to grant sufficient rotation at 90° of abduction. In summary, increased lateralization of the COR and increased subacromial space improve ROM in all CSA configurations. Cite this article: A. Lädermann, E. Tay, P. Collin, S. Piotton, C-H Chiu, A. Michelet, C. Charbonnier. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 2019;8:378–386. DOI: 10.1302/2046-3758.88.BJR-2018-0293.R1.

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The implications of the glenoid angles and rotator cuff status in patients with osteoarthritis undergoing shoulder arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03690-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Omer Ozel ◽

Robert Hudek ◽

Mohamed S. Abdrabou ◽

Birgit S. Werner ◽

Frank Gohlke

Keyword(s):

Computed Tomography ◽

Rotator Cuff ◽

Inclination Angle ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Fatty Infiltration ◽

Critical Shoulder Angle ◽

Software Program ◽

3D Software ◽

Shoulder Angle

Abstract Background The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°. Methods A total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group. Results The median (min/max) values for the 231 shoulders were 8° (− 23°/56°) for the inclination angle, − 11°(− 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders. Conclusion Our findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact. Level of evidence Level III.

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Associations between radiographic parameters in the reverse shoulder arthroplasty and patient outcomes

Shoulder & Elbow ◽

10.1177/17585732211057887 ◽

2021 ◽

pp. 175857322110578

Author(s):

Ahmed Maksoud ◽

Colin Steinlechner ◽

Cheryl Baldwick ◽

William Tabi

Keyword(s):

Patient Outcomes ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Critical Shoulder Angle ◽

Radiological Parameters ◽

Predictive Parameters ◽

The Relationship ◽

Shoulder Angle

Background Various radiological parameters have been measured in the Reverse Shoulder Arthroplasty (RSA) and correlated to patient outcomes, to determine best baseplate position. Results remain unclear with respect to certain parameters such as inferior baseplate tilt. We have investigated our series of patients to clarify the relationship between radiological parameters and patient outcomes. Methods We conducted a UK based bi-centre retrospective review of 156 prostheses. Critical shoulder angle (CSA), RSA angle (RSAA), Overhang and Deltoid Lever Arm (DLA) were measured on preoperative and postoperative radiographs. Range of motion and Oxford Shoulder Score (OSS) (range 1–8 years) were obtained. We assessed for scapular notching at minimum 1 year follow up (n = 138). Results Decreased postoperative CSA and increased DLA were associated with higher OSSs (P = 0.001 and 0.019). Increased overhang and DLA were associated with increased flexion (P = 0.033 and 0.024 respectively). Multivariate analysis showed that CSA and DLA affected notching rate (P = 0.002 and 0.007). Conclusions Baseplate tilt in relation to the acromion (CSA) and DLA are the most predictive parameters for notching and OSS. We recommend considering a maximum CSA of 26 degrees to decrease notching rate and improve OSS. We recommend considering an Overhang of at least 6 mm to improve FF.

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Bony increased-offset reverse shoulder arthroplasty: A meta-analysis of the available evidence

Shoulder & Elbow ◽

10.1177/1758573220916848 ◽

2020 ◽

pp. 175857322091684

Author(s):

Richard Dimock ◽

Mohamed Fathi Elabd ◽

Mohamed Imam ◽

Mark Middleton ◽

Arnaud Godenèche ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Controlled Trial ◽

Meta Analysis ◽

Reverse Shoulder Arthroplasty ◽

Case Series ◽

Autogenous Bone ◽

Radiographic Outcomes ◽

Outcome Scores

Background Reverse shoulder arthroplasty (RSA) has revolutionized the management of many shoulder pathologies. Lateralization has become favourable to combat complications (e.g. notching, compromised external rotation), using a metallic, or autogenous bone-graft baseplates – bony increased-offset reverse shoulder arthroplasty (BIO-RSA). We systematically reviewed the literature to determine: Does BIO-RSA improve range of motion and outcome scores? Are notching rates decreased? Does the graft heal? Methods All available prospective studies, trials and case series reporting on BIO-RSA were included. Outcomes were grouped into outcome scores, range of motion and radiographic outcomes. Data were pooled and statistical analysis performed. Results Eight studies reported on 385 RSA – 235 BIO-RSA and 150 standard-RSA (STD-RSA). Follow-up was 20–36 months; average age 74 years. Outcome scores: Constant-Murley and SSV scores showed statistically significant post-operative benefit of BIO-RSA (mean-difference 4.0 (95% confidence interval (CI): 0.79,7.1) and 6.8 (95% CI: 3.8, 9.9)). No Minimal Clinically Importance Difference was surpassed. Range of motion: No difference was found in any direction. Notching: Notching was less likely with BIO-RSA (odds ratio 0.19 (95% CI: 0.10, 0.38)). Healing and loosening: 92% grafts fully healed/incorporated. Loosening rate was 2.4%. Conclusions Literature on BIO-RSA is limited with only one randomised controlled trial (RCT). Weak evidence exists for improved outcome scores. Range of motion is equivocal. Notching rates are significantly lower in BIO-RSA. The graft usually heals.

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Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty

International Orthopaedics ◽

10.1007/s00264-015-2984-3 ◽

2015 ◽

Vol 39 (11) ◽

pp. 2205-2213 ◽

Cited By ~ 78

Author(s):

Alexandre Lädermann ◽

Patrick J. Denard ◽

Pascal Boileau ◽

Alain Farron ◽

Pierric Deransart ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Stem Design

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Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2011.04.009 ◽

2012 ◽

Vol 21 (1) ◽

pp. 36-41 ◽

Cited By ~ 105

Author(s):

Jason C. Clark ◽

Joseph Ritchie ◽

Frederick S. Song ◽

Michael J. Kissenberth ◽

Stefan J. Tolan ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Complication Rates

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The effect of humeral polyethylene insert constraint on reverse shoulder arthroplasty biomechanics

Shoulder & Elbow ◽

10.1177/1758573217701065 ◽

2017 ◽

Vol 10 (1) ◽

pp. 25-31 ◽

Cited By ~ 2

Author(s):

Irfan Abdulla ◽

Daniel G Langohr ◽

Joshua W. Giles ◽

James A. Johnson ◽

George S. Athwal

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Biomechanical Study ◽

Polyethylene Insert ◽

Muscle Forces ◽

Joint Load ◽

Joint Loads ◽

Load Angle ◽

Active Abduction

Background There is little information on the effects of altering reverse shoulder arthroplasty (RSA) polyethylene constraint on joint load, load angle and deltoid force. The present biomechanical study aimed to investigate the effects of changing RSA polyethylene constraint on joint load, load angle, deltoid force and range of motion. Methods A custom RSA implant capable of measuring forces across the joint with varying polyethylene constraint was tested in six cadaveric shoulders. Standard-, low- and high-constraint (retentive) polyethylene liners were tested, and joint kinematics, loads and muscle forces were recorded. Results When polyethylene constraint was altered, joint load and load angle during active abduction were not affected significantly ( p > 0.19). Additionally, the force required by the deltoid for active abduction was not affected significantly by cup constraint ( p = 0.144). Interestingly, active abduction range of motion was also not affected significantly by changes in cup constraint ( p > 0.45). Conclusions Altering polyethylene cup constraint in RSA to enhance stability does not significantly alter resultant joint loads and deltoid forces. Surprisingly, terminal abduction range of motion was also not significantly different with varying cup constraint, indicating that terminal impingement may be tuberosity related rather than polyethylene.

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Prediction of Impingement-Free Range of Motion Prior to Reverse Shoulder Arthroplasty

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.01.058 ◽

2020 ◽

Vol 29 (4) ◽

pp. e170

Author(s):

Vani J. Sabesan ◽

Jordan Grauer ◽

Bhavya Sheth ◽

Matthew Stankard ◽

Diego J.L. Lima ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Free Range

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Anatomical and reverse shoulder arthroplasty utilizing a single implant system with a platform stem: A prospective observational study with midterm follow-up

Shoulder & Elbow ◽

10.1177/1758573219840675 ◽

2019 ◽

Vol 12 (5) ◽

pp. 330-337

Author(s):

Lindsay Flynn ◽

Matthew R Patrick ◽

Christopher Roche ◽

Joseph D Zuckerman ◽

Pierre-Henri Flurin ◽

...

Keyword(s):

Los Angeles ◽

Range Of Motion ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Outcome Scores ◽

Implant System ◽

Reverse Total Shoulder

Background No studies compare outcomes of anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty with more than five-year follow-up. Methods A multicenter prospectively collected shoulder registry was utilized to review all patients undergoing primary anatomic total shoulder arthroplasty or primary reverse total shoulder arthroplasty with a minimum five-year follow-up utilizing a single platform stem implant system. One-hundred-ninety-one patients received an anatomic total shoulder arthroplasty and 139 patients received a reverse total shoulder arthroplasty. Patients were scored preoperatively and at latest follow-up using the simple shoulder test (SST), University of California Los Angeles (UCLA), American shoulder and elbow surgeons (ASES), Constant, and shoulder pain and disability index (SADI) scores as well as range of motion. Radiographs were evaluated for implant loosening or notching. Complications were reviewed. A Student’s two-tailed, unpaired t-test identified differences in preoperative, postoperative, and pre-to-postoperative improvements. Results Reverse total shoulder arthroplasty patients were significantly older than anatomic total shoulder arthroplasty patients. All patients demonstrated significant improvement in functional metric scores and range of motion following anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty. There was no difference in final outcome scores between anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients at midterm follow-up; however, reverse total shoulder arthroplasty patients demonstrated significantly less motion. Discussion We demonstrate equivalent outcomes with five scoring metrics at mean follow-up of 71.3 ± 14.1 months. Although postoperative scores were significantly greater than preoperative scores for both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients, significant differences in outcome scores between cohorts were not observed.

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