Influence of glenoid component design and humeral component retroversion on internal and external rotation in reverse shoulder arthroplasty: A cadaver study

Introduction Primary reverse shoulder arthroplasty has been reported to provide good outcomes. The majority of designs utilize a large portion of the glenoid. Some studies have reported worrisome rates of notching and stress fractures of the acromion or scapular spine. The purpose of this study was to determine the outcome and complications of a bone-preserving reverse prosthesis with limited ingrowth glenoid surface paired with an onlay humeral component. Materials and methods Between 2014 and 2015, 96 reverse arthroplasties were implanted using a bone-preserving reverse with a 135° onlay humeral bearing. Six patients died. The remaining 87 patients (90 shoulders) were followed for 2 years or until revision. Mean age was 69.3 years. The underlying diagnosis was cuff tear arthropathy (13), irreparable cuff tear (39), osteoarthritis (32), and other (6). Shoulders were followed for 2 years or until revision surgery. Results Reverse shoulder arthroplasty resulted in significant improvements in pain, motion, and function. At most recent follow-up, 74 shoulders had no or mild pain. Elevation was 131° ± 31° and external rotation 46° ± 21°. The mean American Shoulder and Elbow Surgeons (ASES) score was 76. There were 4 reoperations for deep infection (2), periprosthetic fracture, and glenoid loosening. None of the remaining arthroplasties were loose. There was one stress fracture of the acromion and one of the spine of the scapula. No radiographic notching or dislocation was observed. Discussion Primary reverse arthroplasty using a bone-preserving glenoid component and an anatomic onlay humeral bearing provides satisfactory clinical outcomes with a very low rate of failure and complications.

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

The Bone & Joint Journal ◽

10.1302/0301-620x.100b9.bjj-2018-0264.r1 ◽

2018 ◽

Vol 100-B (9) ◽

pp. 1182-1186 ◽

Cited By ~ 21

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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Onlay versus inlay humeral components in reverse shoulder arthroplasty: A systematic review and meta-analysis

Shoulder & Elbow ◽

10.1177/17585732211067171 ◽

2021 ◽

pp. 175857322110671

Author(s):

Garrett R Jackson ◽

Joshua Meade ◽

Bradley L Young ◽

David P Trofa ◽

Shadley C Schiffern ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Meta Analysis ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Forward Flexion ◽

Scapular Fractures ◽

Humeral Component ◽

Significant Difference ◽

Vas Scores

Background Advances have been made to the traditional inlay Grammont Reverse Shoulder Arthroplasty (RSA) design such as the onlay humeral component prosthesis. Currently, there is no agreement in the literature regarding the best option for the humeral component when comparing inlay and onlay designs. This review compares the outcomes and complications between onlay versus inlay humeral components for RSA. Methods A literature search was conducted using PubMed and Embase. Only studies reporting outcomes comparing onlay versus inlay RSA humeral components were included. Results Four studies with 298 patients (306 shoulders) were included. Onlay humeral components were associated with better external rotation (ER) ( p < 0.0001). No significant difference in forward flexion (FF) or abduction was found. Constant scores (CS) and VAS scores did not differ. Increased scapular notching was found in the inlay group (23.18%) versus the onlay group (7.74%) ( p = 0.02). Postoperative scapular fractures and acromial fractures did not differ. Conclusion Onlay and inlay RSA designs are associated with improved postoperative range of motion (ROM). Onlay humeral designs may be associated with greater ER and lower rate of scapular notching; however, no difference was found in Constant and VAS scores, so further studies are required to assess the clinical significance of these differences.

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The biomechanical effectiveness of tendon transfers to restore rotation after reverse shoulder arthroplasty: latissimus versus lower trapezius

Shoulder & Elbow ◽

10.1177/1758573220946257 ◽

2020 ◽

pp. 175857322094625

Author(s):

Kevin Chan ◽

G Daniel G Langohr ◽

George S Athwal ◽

James A Johnson

Keyword(s):

Internal Rotation ◽

Shoulder Arthroplasty ◽

Latissimus Dorsi ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Pectoralis Major ◽

Tendon Transfers ◽

Humeral Component ◽

Pectoralis Major Transfer ◽

Lower Trapezius

Background The purpose of this biomechanical simulator study was primarily to compare latissimus dorsi to lower trapezius tendon transfers for active external rotation and the pectoralis major transfer for internal rotation after reverse shoulder arthroplasty. Secondarily, the role of humeral component lateralization on transfer function was assessed. Methods Eight rotator cuff deficient cadavers underwent reverse shoulder arthroplasty with an adjustable lateralization humeral component. Latissimus dorsi and lower trapezius transfers were compared for active external rotation restoration and pectoralis major transfer for internal rotation restoration. Internal rotation/external rotation torques were measured for each lateralization at varying abduction and internal rotation/external rotation ranges-of-motion. Results The lower trapezius transfer generated, on average, 1.6 ± 0.2 nm more torque than the latissimus dorsi transfer (p < 0.001). The internal rotation/external rotation torques of all tendon transfers decreased as abduction increased (p < 0.01). At 0° elevation, reverse shoulder arthroplasty humeral component lateralization had a significant positive effect on tendon transfer torque at 60° internal rotation and external rotation (p < 0.01). Discussion Both the lower trapezius and the latissimus dorsi tendon transfers were effective in restoring active external rotation after reverse shoulder arthroplasty; however, the lower trapezius generated significantly more torque. Additionally, the pectoralis major transfer was effective in restoring active internal rotation. All tendon transfers were optimized with greater humeral component lateralization.

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Current Concepts in Humeral Component Design for Anatomic and Reverse Shoulder Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm10215151 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5151

Author(s):

Joaquin Sanchez-Sotelo

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Computer Assisted ◽

Optimal Plan ◽

Humeral Component ◽

Component Design ◽

History Of ◽

Preoperative Plan ◽

Short Stems ◽

Tissue Tension

The history of humeral component design has evolved from prostheses with relatively long stems and limited anatomic head options to a contemporary platform with short stems and stemless implants with shared instrumentation and the ability to provide optimal shoulder reconstruction for both anatomic and reverse configurations. Contemporary humeral components aim to preserve the bone, but they are potentially subject to malalignment. Modern components are expected to favorably load the humerus and minimize adverse bone reactions. Although there will likely continue to be further refinements in humeral component design, the next frontiers in primary shoulder arthroplasty will revolve around designing an optimal plan, including adequate soft tissue tension and providing computer-assisted tools for the accurate execution of the preoperative plan in the operating room.

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Imaging of shoulder arthroplasties and their complications: a pictorial review

Insights into Imaging ◽

10.1186/s13244-019-0788-5 ◽

2019 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Damien Combes ◽

Romain Lancigu ◽

Patrick Desbordes de Cepoy ◽

Filippo Caporilli-Razza ◽

Laurent Hubert ◽

...

Keyword(s):

Joint Replacement ◽

Shoulder Arthroplasty ◽

Shoulder Joint ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Glenoid Component ◽

Humeral Component ◽

Number Of Patients ◽

Component Loosening ◽

Shoulder Arthroplasties

Abstract Currently, an increasing number of patients benefit from shoulder prosthesis implantation. Radiologists are therefore more often confronted with imaging examinations involving shoulder arthroplasty, whether during a dedicated examination or incidentally. Standard radiography is the first-line imaging modality in the follow-up of these implants, before the possible use of cross-sectional imaging modalities (computed tomography and magnetic resonance imaging), ultrasound, or nuclear medicine examinations. Shoulder arthroplasties are divided into three categories: reverse shoulder arthroplasty, total shoulder arthroplasty, and partial shoulder joint replacement (including humeral hemiarthroplasty and humeral head resurfacing arthroplasty). Each of these prostheses can present complications, either shared by all types of arthroplasty or specific to each. Infection, periprosthetic fractures, humeral component loosening, heterotopic ossification, implant failure, and nerve injury can affect all types of prostheses. Instability, scapular notching, and acromial fractures can be identified after reverse shoulder arthroplasty implantation. Glenoid component loosening and rotator cuff tear are specific complications of total shoulder arthroplasty. Progressive wear of the native glenoid is the only specific complication observed in partial shoulder joint replacement. Knowledge of different types of shoulder prostheses and their complications’ radiological signs is crucial for the radiologist to initiate prompt and adequate management.

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Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/1758573220936234 ◽

2020 ◽

pp. 175857322093623

Author(s):

Georges Haidamous ◽

Alexandre Lädermann ◽

Robert U Hartzler ◽

Bradford O Parsons ◽

Evan S Lederman ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Level Of Evidence ◽

Component Size ◽

Excellent Outcome ◽

Forward Flexion ◽

Humeral Component ◽

Radiographic Measurements

Background The purpose was to evaluate the relationship of component size and position to postoperative range of motion following reverse shoulder arthroplasty. The hypothesis was that increased lateralization, larger glenospheres, and a decreased acromiohumeral distance would be associated with excellent postoperative range of motion. Methods A retrospective multicenter study was performed at a minimum of one year postoperatively on 160 patients who underwent primary reverse shoulder arthroplasty with a 135° humeral component. Outcomes were stratified based on postoperative forward flexion and external rotation into excellent ( n = 42), defined as forward flexion >140° and external rotation > 30°, or poor ( n = 36), defined as forward flexion <100° and external rotation < 15°. Radiographic measurements and component features were compared between the two groups. Results A larger glenosphere size was associated with an excellent outcome ( p = 0.009). A 2-mm posterior offset humeral cup ( p = 0.012) and an increased inferior glenosphere overhang (3.1 mm vs 1.4 mm; p = 0.002) were also associated with excellent outcomes. Humeral lateralization and distalization were not associated with an excellent outcome. Conclusion: Larger glenosphere size and inferior positioning as well as posterior humeral offset are associated with improved postoperative range of motion following reverse shoulder arthroplasty. Level of Evidence Level 3, retrospective comparative study.

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Can a reverse shoulder arthroplasty be used to revise a failed primary reverse shoulder arthroplasty?

The Bone & Joint Journal ◽

10.1302/0301-620x.100b11.bjj-2018-0226.r2 ◽

2018 ◽

Vol 100-B (11) ◽

pp. 1493-1498 ◽

Cited By ~ 14

Author(s):

E. R. Wagner ◽

M. Hevesi ◽

M. T. Houdek ◽

R. H. Cofield ◽

J. W. Sperling ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Survival Rates ◽

Salvage Procedure ◽

Simple Shoulder Test ◽

Humeral Component ◽

Increased Risk ◽

The Mean

Aims Patients with a failed reverse shoulder arthroplasty (RSA) have limited salvage options. The aim of this study was to determine the outcome of revision RSA when used as a salvage procedure for a failed primary RSA. Patients and Methods We reviewed all revision RSAs performed for a failed primary RSA between 2006 and 2012, excluding patients with a follow-up of less than two years. A total of 27 revision RSAs were included in the study. The mean age of the patients at the time of revision was 70 years (58 to 82). Of the 27 patients, 14 (52% were female). The mean follow-up was 4.4 years (2 to 10). Results Six patients (22%) developed complications requiring further revision surgery, at a mean of 1.7 years (0.1 to 5.3) postoperatively. The indication for further revision was dislocation in two, glenoid loosening in one, fracture of the humeral component in one, disassociation of the glenosphere in one, and infection in one. The five-year survival free of further revision was 85%. Five additional RSAs developed complications that did not need surgery, including dislocation in three and periprosthetic fracture in two. Overall, patients who did not require further revision had excellent pain relief, and significant improvements in elevation and external rotation of the shoulder (p < 0.01). The mean postoperative American Shoulder and Elbow Surgeons (ASES), and simple shoulder test (SST) scores were 66 and 7, respectively. Radiological results were available in 26 patients (96.3%) at a mean of 4.3 years (1.5 to 9.5). At the most recent follow-up, six patients (23%) had glenoid lucency, which were classified as grade III or higher in three (12%). Smokers had a significantly increased risk of glenoid lucency (p < 0.01). Conclusion Revision RSA, when used to salvage a failed primary RSA, can be a successful procedure. At intermediate follow-up, survival rates are reasonable, but dislocation and glenoid lucency remain a concern, particularly in smokers. Cite this article: Bone Joint J 2018;100-B:1493–98.

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