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

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.

Download Full-text

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

JSES Open Access ◽

10.1016/j.jses.2019.10.032 ◽

2019 ◽

Vol 3 (4) ◽

pp. 240

Author(s):

Alexandre Lädermann ◽

Eileen Tay ◽

Philippe Collin ◽

Joe Chih-Hao Chiu ◽

Caecilia Charbonnier

Keyword(s):

Range Of Motion ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Critical Shoulder Angle ◽

Shoulder Angle

Download Full-text

Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching

Obere Extremität ◽

10.1007/s11678-020-00594-w ◽

2020 ◽

Vol 15 (3) ◽

pp. 207-212

Author(s):

Patric Raiss ◽

Rainer Neumann

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Complication Rates ◽

Level Of Evidence ◽

Scapular Notching ◽

Neck Shaft Angle ◽

Shoulder Flexion

Abstract Introduction Reverse shoulder arthroplasty (RSA) has become a well-established treatment option for multiple disorders of the shoulder joint. In recent years, implant designs and configurations have been modified in order to improve function and avoid complications. Lateralization on the glenoid and the humeral side has been described to improve function and decrease radiographic scapular notching. Data on the clinical and radiographic results of bipolar lateralization in RSA are lacking. Methods In 38 cases, RSA was performed using an uncemented humeral short-stem component with a 145° neck–shaft angle in combination with bone lateralization on the glenoid side (Bony Increased-Offset Reversed Shoulder Arthroplasty, BIO-RSA; Wright Medical Inc., Memphis, TN, USA). Mean follow-up was 19 months (range 12–34 months). Patients were followed clinically using the Constant score as well as range of motion for shoulder flexion and external rotation. Radiographs in two different plains were analyzed for implant seating and the occurrence of scapular notching. Results There was a significant increase in all measured clinical parameters. Forward flexion increased from a mean of 75° preoperatively to 151° postoperatively, and mean Constant score increased from 21 to 71 points postoperatively (p < 0.001). Glenoid notching of grade 1 according to Sirveuax was observed in 3 out of 35 cases (9%); no grade 2, 3, or 4 notching was present. Revision surgery was necessary in one case (3%). Conclusion RSA with bipolar lateralization leads to excellent clinical outcomes, low complication rates, and low rates of radiographic scapular notching. Longer follow-up and prospective randomized trials are needed. Level of evidence Level IV.

Download Full-text

Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty

Bone and Joint Research ◽

10.1302/2046-3758.88.bjr-2018-0293.r1 ◽

2019 ◽

Vol 8 (8) ◽

pp. 378-386 ◽

Cited By ~ 5

Author(s):

Alexandre Lädermann ◽

Eileen Tay ◽

Philippe Collin ◽

Sébastien Piotton ◽

Chih-Hao Chiu ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Subacromial Space ◽

Range Of Movement ◽

Neck Shaft Angle ◽

Critical Shoulder Angle ◽

Flexion Extension ◽

The Impact ◽

Shoulder Angle

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.

Download Full-text

Is limited external rotation after reverse shoulder arthroplasty associated with glenoidal notching?

Obere Extremität ◽

10.1007/s11678-021-00668-3 ◽

2021 ◽

Author(s):

Alexandra Grob ◽

Samy Bouaicha ◽

Marco Germann ◽

Sabra Germann ◽

Christian Gerber ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Radiographic Progression ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Cuff Tear ◽

Over Time

Abstract Background Reverse shoulder arthroplasty (RSA) is a valuable solution for patients with shoulder pain or injury primarily due to a rotator cuff tear or secondary to traumatic events. Nevertheless, several complications are known to appear, with the most frequent being scapular notching (SN) on the inferior and posterior scapular neck. Controversial data exist about the clinical relevance of SN. Since further consequences are still not clearly understood, we aimed to provide more clarity on which factors, especially external rotation (ER), contribute to the appearance and progress of notching. Methods Constant Score (CS), Subjective Shoulder Value (SSV), flexion, abduction, and ER were evaluated retrospectively in 153 shoulders of 147 patients (mean age 79±7.7 years; 62% women) who underwent RSA between 2005 and 2010. Anteroposterior radiographs were evaluated before and 1, 2, 3, and 5 years after RSA for SN according to the Sirveaux classification. The evaluation was performed by two independent surgeons. Spearman’s coefficient and t-test were used. Results CS, SSV, flexion, and abduction increased significantly 1 year after RSA compared to before (all p < 0.0001). No improvement was shown for ER between the same timepoints. Between 2 and 5 years of follow-up, only flexion decreased by 5°(p = 0.02) while CS, SSV, abduction, and ER remained constant. After RSA, notching increases over time. There was no association between SN and CS, SSV, flexion, abduction or ER at any of the measured timepoints. Higher flexion correlated with higher abduction after RSA at every follow-up (1 year r = 0.88, 2 years r = 0.89, 3 years r = 0.86, 5 years r = 0.86). The interrater correlation test showed a strong correlation (r = 0.7). Conclusion We verified the functional benefits of RSA for patients. Additionally, our findings show that despite radiographic progression of notching and unchanged limited ER, the postoperative improvements in CS, SSV, flexion, and abduction are preserved over 5 years.

Download Full-text

The relationship between scapular notching and reverse shoulder arthroplasty prosthesis design

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2011.08.051 ◽

2012 ◽

Vol 21 (10) ◽

pp. 1430-1441 ◽

Cited By ~ 31

Author(s):

Marc S. Kowalsky ◽

Leesa M. Galatz ◽

Derek S. Shia ◽

Karen Steger-May ◽

Jay D. Keener

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Prosthesis Design ◽

Scapular Notching ◽

The Relationship

Download Full-text

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.

Download Full-text