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

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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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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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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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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Postoperative stiffness after reverse total shoulder arthroplasty

Shoulder & Elbow ◽

10.1177/1758573220967312 ◽

2020 ◽

pp. 175857322096731

Author(s):

Mohammad Ghoraishian ◽

Brian W Hill ◽

Thema Nicholson ◽

Matthew L Ramsey ◽

Gerald R Williams ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Patient Reported Outcome ◽

Implant Design ◽

Consecutive Series ◽

Patient Reported ◽

Outcome Scores ◽

One Year

Purpose The purpose of this study was to evaluate the rate and risk factors for stiffness after reverse shoulder arthroplasty and the ramifications on the patient-reported outcomes. Method A consecutive series of patients who underwent reverse shoulder arthroplasty were prospectively followed for one year. Passive range of motion was measured preoperatively and at regular intervals postoperatively. Patients with passive forward elevation of less than 100° or passive external rotation of less than 30° were defined as stiff. Radiographic parameters and postoperative patient-reported outcome scores were collected. Results Seventy-six patients were available for review. The prevalence of postoperative stiffness following reverse shoulder arthroplasty was 47% at three months, 31% at six months, and 25% at one year. Preoperative shoulder stiffness was associated with three-month postoperative stiffness only. In patients with one-year stiffness, smaller ( p = 0.03) and less lateralized glenospheres ( p = 0.024) were more common. Stiffness was not associated with one-year patient-reported outcome scores. Conclusion Stiffness is common after reverse shoulder arthroplasty and often improves at one-year after surgery. Implant design and selection may be important determinants of passive range of motion. While stiffness does not appear to influence patient-reported outcome scores, one of four patients will potentially have stiffness one year following reverse shoulder arthroplasty. Level of evidence: Level III; retrospective study.

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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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Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.616104 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shu-Kun He ◽

Jing-Ping Liao ◽

Jin-Hai Guo ◽

Fu-guo Huang

Keyword(s):

Shoulder Arthroplasty ◽

Functional Outcomes ◽

Healing Rate ◽

External Rotation ◽

Meta Analysis ◽

Reverse Shoulder Arthroplasty ◽

Cochrane Library ◽

Greater Tuberosity ◽

Complex Proximal Humeral Fractures ◽

The Cochrane Library

Introduction: Reverse shoulder arthroplasty (RSA) is becoming popular in the treatment of complex proximal humeral fractures (PHFs). Greater tuberosity healing may influence functional outcomes and range of motion (ROM) of shoulder after RSA. In addition, the design of prosthesis may impact the healing rate of greater tuberosity. The purpose of this study is to know: (1) does the healing of greater tuberosity affect the functional outcomes and ROM of shoulder? and (2) does the design of prosthesis affect the healing rate of greater tuberosity?Materials and Methods: PubMed, Ovid/Embase, and the Cochrane Library were searched for studies comparing the clinical outcomes between the healed groups and the non-healed groups after RSA.Results: For functional outcomes, the results showed that the healed group had better Constant scores (CSs) (p < 0.0001). For ROM, the healed group showed better flexion (p < 0.0001), abduction (p = 0.02), and external rotation (p < 0.00001) of shoulder. For the design of prosthesis, the mean healing rate of greater tuberosity (82.7%) in patients with fracture-dedicated prosthesis was higher than those (63.0%) in patients with standard prosthesis. Subgroup analyses showed that the CS (p = 0.12) and abduction (p = 0.96) of patients using fracture-dedicated prostheses were not different between the healed groups and the non-healed groups. Meta-regression showed that there was no significant relationship between the design of prosthesis and CS (p = 0.312), flexion (p = 0.422), or external rotation (p = 0.776).Conclusion: Our meta-analysis showed that the healed groups could obtain better functional outcomes and ROM than the non-healed groups. In addition, fracture-dedicated prostheses promoted the healing rate of greater tuberosity.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020157276, PROSPERO: CRD42020157276.

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Reverse Shoulder Arthroplasty for Primary Synovial Osteochondromatosis of the Shoulder with Massive Rotator Cuff Tear and Marked Degenerative Arthropathy

Journal of Clinical Medicine ◽

10.3390/jcm7080189 ◽

2018 ◽

Vol 7 (8) ◽

pp. 189

Author(s):

Toru Ichiseki ◽

Shusuke Ueda ◽

Daisuke Souma ◽

Miyako Shimasaki ◽

Yoshimichi Ueda ◽

...

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

Shoulder Arthroplasty ◽

Histopathological Examination ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Functional Improvement ◽

Floating Body ◽

Left Shoulder ◽

Synovial Osteochondromatosis

Synovial osteochondromatosis (SO) is a rare disease in which chondrometaplasia develops in the synovium of joints, bursa, and tendon sheaths. SO is found most frequently in the knee joint, while cases of SO developing in the shoulder joint are rare, accounting for only 1.9–5.2% of all SO cases. Moreover, most of these cases show secondary rather than primary involvement. In a patient with SO associated with extensive rotator cuff tearing and marked arthropathic changes, we performed mass resection and reverse shoulder arthroplasty (RSA), and obtained good pain relief and functional improvement. The patient was a 75-year-old woman who had developed left shoulder pain five years earlier without any known precipitating factor. The range of motion of the left shoulder showed extremely severe restriction, with flexion 80°, abduction 60°, and external rotation 0°, and prominent impingement symptoms. On plain radiographs and computed tomography (CT), prominent shoulder arthropathic changes were found. On plain magnetic resonance imaging (MRI), around the shoulder, an irregular hypointense region was identified in the center on T1-enhanced images, while hyperintense nodular lesions with a hypointense center were detected on T2-enhanced images. Since extensive rotator cuff tearing was also found, a diagnosis of OS associated with rotator cuff tearing and arthropathic changes was made. Surgery consisted of resection of a whitish mass-like floating body in the center of the joint followed by RSA. The postoperative course was uneventful, and one year postoperatively there was no recurrence of pain and the range of motion of the left shoulder had improved to flexion 140°, abduction 130°, and external rotation 30°. Moreover, no complications such as recurrence of osteochondromatosis, implant loosening, or infection were seen. On histopathological examination, the loose body was found to consist of a cartilage component and bone tissue with hyalinization. No findings indicative of malignancy were apparent, and since nodular cartilage arrangement was found, primary osteochondroma was diagnosed. These findings suggested that physical friction between the rotator cuff and the mass was the cause of the rotator cuff tearing, and that the extensive rotator cuff tearing accounted for the progression of the associated extremely severe arthropathic changes.

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Reverse Shoulder Arthroplasty Using a Bone-preserving Glenoid Component: Clinical and Radiographic Outcomes

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549218761684 ◽

2018 ◽

Vol 2 ◽

pp. 247154921876168 ◽

Cited By ~ 1

Author(s):

Joaquin Sanchez-Sotelo ◽

Ngoc Tram V Nguyen ◽

Mark E Morrey

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Deep Infection ◽

Glenoid Component ◽

Cuff Tear ◽

Radiographic Outcomes ◽

Humeral Component ◽

And Function ◽

Rate Of Failure

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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Influence of humeral stem inclination in reverse shoulder arthroplasty on range of motion: a meta-analysis

JSES Reviews, Reports, and Techniques ◽

10.1016/j.xrrt.2021.02.002 ◽

2021 ◽

Vol 1 (2) ◽

pp. 102-112

Author(s):

Lode Holsters ◽

Nasrât Sadeghi ◽

Helene Gendera ◽

Vincent Groen ◽

Vivian Bruls ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Meta Analysis ◽

Reverse Shoulder Arthroplasty

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Can surgeons optimize range of motion and reduce scapulohumeral impingements in reverse shoulder arthroplasty? A computational study

Shoulder & Elbow ◽

10.1177/1758573221994141 ◽

2021 ◽

pp. 175857322199414

Author(s):

Marc-Olivier Gauci ◽

Jean Chaoui ◽

Julien Berhouet ◽

Adrien Jacquot ◽

Gilles Walch ◽

...

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Computational Study ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Lower Range ◽

Greater Tuberosity ◽

Planning Software ◽

Made In

Background Early glenohumeral impingement leads to poor range of motion and notching in reverse shoulder arthroplasty. The aim was to find from planning software which implant configuration provides the best motions in reverse shoulder arthroplasty. Patients and Methods Reverse shoulder arthroplasty planning (Glenosys) was made in 31 patients (12 men, 19 women, 76 ± 6 yo) and impingements were analyzed. Inlay (155°-inclined) and Onlay (145°-inclined) humeral designs were tested. Four configurations were tested for each shoulder: “INLAY”: non-lateralized glenoid-inlay humerus, “BIO-INLAY”: lateralized glenoid (BIO-RSA)-inlay humerus, “ONLAY”: non-lateralized glenoid-onlay humerus, and “BIO-ONLAY”: lateralized (BIO-RSA) glenoid-onlay humerus. Results BIO-ONLAY and BIO-INLAY groups presented a significantly better result in all tested motion ( p < 0.001 for all tests). BIO-ONLAY allowed a significantly better external rotation, extension and adduction than BIO-INLAY with decreased impingements with the pilar. BIO-INLAY presented a significantly better abduction. In abduction, an abutment of the greater tuberosity against the acromion was associated with a lower range of motion ( p < 0.0001) and did not depend on the lateralization. Conclusion Glenoid lateralization delays the glenohumeral impingement in reverse shoulder arthroplasty and gives the best rotations, adduction and extension when associated with neutral inclination and humeral 145° inclination. Greater tuberosity abutment has to be avoided in abduction and the Inlay design provides the best abduction.

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