scholarly journals Comparison of Lateralized Versus Medialized Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-analysis

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110639
Author(s):  
Sung-Hyun Cho ◽  
Hyo-Jin Lee ◽  
Osama R. Aldhafian ◽  
Yang-Soo Kim
Keyword(s):  
Systematic Review ◽  
Pain Score ◽  
Complication Rate ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Level Of Evidence ◽  
Scapular Notching ◽  
Functional Scores ◽  
Reverse Total Shoulder

Background: Reverse total shoulder arthroplasty (rTSA) is an established procedure for cuff tear arthropathy. More lateralized prostheses have been designed to overcome the reported adverse outcomes of Grammont-style rTSA. Purpose: To compare the clinical and radiological outcomes of medialized and lateralized center of rotation (COR) in rTSA. Study Design: Systematic review; Level of evidence, 3. Methods: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies with a level of evidence ≥3 that compared medialized and lateralized rTSA with a minimum follow-up of 12 months. Functional scores including the American Shoulder and Elbow Surgeons (ASES) score and Constant score (CSS), range of motion at final follow-up, gain of external rotation (ER), visual analog scale (VAS) pain score, scapular notching, and heterotopic ossification (HO) were compared. Data were analyzed using random-effects or fixed-effects models in accordance with heterogeneity. Results: Five retrospective cohort studies and 1 randomized controlled study (n = 594 patients) were included. Lateralized rTSA resulted in greater improvement in ER degree ( P < .001), a lower VAS pain score (standardized mean difference [SMD], –0.39; P = .002), and a lower rate of scapular notching (risk ratio [RR], 0.40; P < .001) and HO (RR, 0.52; P < .001). Final forward flexion (SMD, –0.14; P = .629) and ER (SMD, 0.21; P = .238) did not differ significantly between the 2 groups. Overall functional scores, including ASES score (SMD, 0.22; P = .310) and CSS (SMD, 0.37; P = .077), also did not differ significantly (SMD, 0.28; P = .062). The overall complication rate did not differ significantly between the 2 groups (RR, 0.71; P = .339). Conclusion: Compared with medialized rTSA, lateralized COR rTSA results in greater improvement in ER and the VAS pain score, decreased rates of scapular notching and HO, and no significant changes in functional outcome scores or the complication rate.

scholarly journals Return to sport after shoulder arthroplasty: a systematic review

2021 ◽  
Vol 6 (9) ◽  
pp. 771-778
Author(s):  
Julie Küffer ◽  
Mohy E. Taha ◽  
Pierre Hoffmeyer ◽  
Gregory Cunningham
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Sport Activity ◽  
Return To Sport ◽  
Level Of Evidence ◽  
The Mean ◽  
Reverse Total Shoulder ◽  
Mean Time

The main goal of this study was to determine the rate of return to sport (RTS) after shoulder arthroplasty. A systematic review of the literature was performed using the PRISMA guidelines. All clinical studies written in English, French or German, with a level of evidence of 1 to 4, and evaluating return to sport after shoulder arthroplasty, were included. A total of 23 studies were included with 2199 patients who underwent hemiarthroplasty (HA), anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RSA). Mean age was 68 years (range 18 to 92.6), sex ratio (male:female) was 1:1.5. The surgery was performed on the non-dominant/dominant shoulder in 1:1.8 cases. The mean follow-up was 4.2 years. The rate of RTS was 75.5% with a mean time of 7 months. It was 77.4% for TSA, 75% for RSA and 71.2% for HA (P = non-significant). RTS after shoulder arthroplasty is high, regardless the type of arthroplasty, with a trend for a higher rate after TSA. Patients who were able to maintain a sport activity preoperatively had a greater chance of RTS after arthroplasty. Failure to RTS seems to be mostly linked to the severity of the underlying condition and length of preoperative disability. Cite this article: EFORT Open Rev 2021;6:771-778. DOI: 10.1302/2058-5241.6.200147

scholarly journals Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

2021 ◽  
Vol 24 (3) ◽  
pp. 125-134
Author(s):  
Kirtan Tankshali ◽  
Dong-Whan Suh ◽  
Jong-Hun Ji ◽  
Chang-Yeon Kim
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Intraoperative Complications ◽  
Total Shoulder Arthroplasty ◽  
Asian Population ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

Reverse total shoulder arthroplasty

2021 ◽  
pp. 1-9
Author(s):  
Eleanor G. Burden ◽  
Timothy J. Batten ◽  
Christopher D. Smith ◽  
Jonathan P. Evans
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Implant Design ◽  
Complication Rates ◽  
Scapular Notching ◽  
Cuff Tear ◽  
Patient Reported ◽  
Reverse Total Shoulder

Aims This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). Methods A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). Results A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies. Conclusion This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design.

scholarly journals Does Humeral Component Version Affect Range of Motion and Clinical Outcomes in Reverse Total Shoulder Arthroplasty? A Systematic Review

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.

scholarly journals Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Hyojune Kim ◽  
Chul-Ho Kim ◽  
Minsoo Kim ◽  
Wonsun Lee ◽  
In-Ho Jeon ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Functional Scores ◽  
Reverse Total Shoulder ◽  
Glenoid Loosening

Abstract Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

Impact of scapular notching on reverse total shoulder arthroplasty outcomes—5 year minimum follow-up

2019 ◽  
Vol 28 (6) ◽  
pp. e204-e205 ◽  
Author(s):  
Ryan W. Simovitch ◽  
Joseph D. Zuckerman ◽  
Thomas W. Wright ◽  
Pierre-Henri Flurin ◽  
Christopher Roche
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

Reassessing glenoid inclination in reverse total shoulder arthroplasty with glenosphere lateralization

2021 ◽  
Vol 103-B (2) ◽  
pp. 360-365
Author(s):  
Kuhan A. Mahendraraj ◽  
Maggie V. Shields ◽  
Florian Grubhofer ◽  
Samuel W. Golenbock ◽  
Andrew Jawa
Keyword(s):  
Heterotopic Ossification ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Patient Reported ◽  
Reverse Total Shoulder

Aims Existing literature indicates that inferiorly inclined glenoid baseplates following reverse total shoulder arthroplasty (RSA) produce better outcomes compared to superiorly inclined baseplates. We aim to compare clinical outcomes for RSAs with superiorly and neutrally/inferiorly inclined lateralized glenospheres. Methods We retrospectively reviewed 154 consecutive patients undergoing RSA between July 2015 and July 2017 by one single-fellowship trained surgeon (AJ). Two raters (KAM and MVS) independently measured glenoid inclination in preoperative and minimum two year follow-up radiographs (anteroposterior/Grashey) using the RSA angle. Inclination was then compared to patient-reported outcomes, range of motion (ROM), and independently assessed degree of scapular notching and staging of heterotopic ossification at two year follow-up. Results Median postoperative inclination for each group was found to be -3.6° (interquartile range (IQR) -2.1 to -6.9) and 6.0° (3.2° to 10.1°) for the neutrally/inferiorly and superiorly inclined cohorts, respectively. Preoperative inclination was highly associated with postoperative inclination (p = 0.004). When comparing superiorly and neutrally/inferiorly inclined glenospheres, there were no differences in heterotopic ossification (p = 0.606), scapular notching (p = 0.367), American Shoulder and Elbow Surgeons score (p = 0.419), Single Assessment Numeric Evaluation (p = 0.417), Visual Analogue Scale (VAS) pain score (p = 0.290), forward elevation (p = 0.161), external rotation (p = 0.537), or internal rotation (p = 0.656). Conclusion Compared to neutral and inferior inclination, up to 6° ± 3° of superior glenoid baseplate inclination on a lateralized RSA design produces no differences in postoperative ROM or patient-reported outcomes, and produces similar levels of scapular notching and heterotopic ossification. Additionally, the degree of preoperative inclination represents an important factor in surgical decision-making as it is strongly associated with postoperative inclination. It is important to note that the findings of this study are only reflective of lateralized RSA prostheses. Cite this article: Bone Joint J 2021;103-B(2):360–365.

scholarly journals Rate of Improvement in Outcomes Measures After Reverse Total Shoulder Arthroplasty: A Longitudinal Study With 2-Year Follow-up

2019 ◽  
Vol 3 ◽  
pp. 247154921986144 ◽  
Author(s):  
Edward Shields ◽  
Denise M Koueiter ◽  
J Michael Wiater
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Outcome Data ◽  
Reverse Total Shoulder Arthroplasty ◽  
Time Points ◽  
Functional Scores ◽  
Average Patient ◽  
Reverse Total Shoulder ◽  
Rate Of Improvement

Background Few studies report rate of improvement following reverse total shoulder arthroplasty (RTSA) in a single cohort. The purpose of this study was to compare functional scores following RTSA across postoperative time points in patients who have follow-up scores available at all selected time points. Methods A prospective database was retrospectively queried for patients with functional outcome data from preoperatively and after RTSA at 3 to 6 months, 1 year, and 2 years, excluding any patients with data missing at these points. All patients included had measures from every time point. Collected outcomes included American Shoulder and Elbow Surgeons (ASES), visual analog scale pain, subjective shoulder value (SSV), and range of motion. Results Outcomes from 173 shoulders were analyzed. Average age was 68 ± 9 years, 68% were females, and 15% were revision cases. The average preoperative ASES score (33 ± 17) improved to 73 ± 18 at 3 to 6 months, 80 ± 19 at 1 year, and 81 ± 19 at 2 years after RTSA. Only outcomes at 1 and 2 years were not significantly different ( P = 1.0). SSV scores and forward elevation followed this pattern, with large improvements in the first 3 to 6 months, then reaching a plateau at 1 year. External and internal rotations did not improve by 3 to 6 months, but did significantly improve by 1 year, and remained stable through 2 years. Pain scores improved from 6.8 points before surgery to roughly 1.3 points at all subsequent time points. Conclusions Patients undergoing RTSA can expect significant reductions in pain and the majority of their functional gains to occur in the first 6 months after surgery. At 12 months after RTSA, the average patient will achieve maximal improvement.

Stemless reverse total shoulder arthroplasty: a systematic review of short- and mid-term results

2021 ◽  
pp. 175857322110133
Author(s):  
Eva Y Liu ◽  
Dorsa Kord ◽  
Nicholas J Yee ◽  
Nolan S Horner ◽  
Latifah Al Mana ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Weighted Mean ◽  
Surgical Time ◽  
Functional Scores ◽  
Reverse Total Shoulder ◽  
Mid Term Results

Introduction Stemless reverse total shoulder arthroplasty is used to treat rotator cuff deficient arthropathies, rheumatoid arthritis, and osteoarthritis. It has several advantages over the stemmed implant including preservation of bone stock, reduced surgical time, and easier revision. Methods A systematic search was conducted in MEDLINE, EMBASE, PubMed, and CENTRAL to retrieve all relevant studies evaluating stemless reverse total shoulder arthroplasty. Results The literature search identified 1993 studies out of which 7 studies were included in this review; 324 patients underwent stemless reverse total shoulder arthroplasty with a weighted mean age of 74.1 (SD = 8.6, range = 38 to 93) years and a weighted mean follow-up time of 44 (SD = 6.6, range = 3 to 95) months. The included studies reported significant improvements in range of motion and functional scores comparable to stemmed reverse total shoulder arthroplasty. The weight mean flexion and abduction was (135 ± 12)° and (131 ± 12)° post-operatively, respectively. The weighted mean constant score increased from (26.7 ± 5.2) Patients (pts) to (63.0 ± 8.0) pts post-operatively. Overall complication and revision rate were 12.3% and 5.2%. Conclusion Early and mid-term results indicate stemless reverse total shoulder arthroplasty has similar clinical outcomes to stemmed reverse total shoulder arthroplasty. There was no radiological evidence of humeral loosening at the latest follow-up.

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