scholarly journals Reverse Total Shoulder Arthroplasty Baseplate Stability in Superior Bone Loss With Augmented Implant

2021 ◽  
Vol 5 ◽  
pp. 247154922110206
Author(s):  
Elise J Martin ◽  
Thomas R Duquin ◽  
Mark T Ehrensberger
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Biomechanical Properties ◽  
Image Correlation ◽  
Abduction Angle ◽  
Glenoid Defect ◽  
Significant Difference ◽  
Reverse Total Shoulder

Background Glenoid bone loss is commonly encountered in cases of rotator cuff tear arthropathy and can create challenges during reverse shoulder arthroplasty. In this study, we sought to investigate the biomechanical properties of a new treatment option for superior glenoid defect, an augmented reverse total shoulder baseplate. Methods Three conditions were examined: non-augmented baseplate without defect, non-augmented baseplate with defect, and augmented baseplate with defect. The augmented baseplates included a 30-degree half wedge which also matched the created superior defect. The samples were cyclically loaded at a 60° simulated abduction angle to mimic baseplate loosening. The migration and micromotion of the baseplate were measured on the superior edge using a 3D Digital Image Correlation System. Results The migration measured in the augmented baseplate showed no significant difference when compared to the no defect or defect cases. In terms of micromotion, the augmented baseplate showed values that were between the micromotions reported for the no defect and defect conditions, but not by a statistically significant amount. Conclusion This study provides biomechanical evidence that augmented baseplates can reduce the amount of micromotion experienced by the RSA construct in the presence of significant superior glenoid bone deficiency, but do not fully restore stability to that of a full contact non-augmented baseplate.

Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review

2020 ◽  
pp. 175857322091765
Author(s):  
Betty Zhang ◽  
Gavinn Niroopan ◽  
Chetan Gohal ◽  
Bashar Alolabi ◽  
Timothy Leroux ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Bone Grafting ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Level Of Evidence ◽  
Total Shoulder Arthroplasties ◽  
Component Loosening ◽  
Shoulder Arthroplasties

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

Comparison of Methods to Predict Scapular Notching From Radiographs After Reverse Total Shoulder Arthroplasty

2012 ◽  
Author(s):  
Heath B. Henninger ◽  
Michael D. Harris ◽  
Kristen R. Petersen ◽  
Robert T. Burks ◽  
Robert Z. Tashjian
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
A Priori ◽  
Stress Shielding ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Implant Placement ◽  
And Function ◽  
Reverse Total Shoulder

Scapular notching is a complication of reverse total shoulder arthroplasty (rTSA) that results in bone loss on the lateral border of the scapula. Notching has been reported in up to 86% of patients at 5 year follow-up [1], and is graded 1–4 as a function of progressive bone loss [2]. Notching may arise from impingement, erosion, periprosthetic osteolysis, stress shielding or a combination of these [1]. Glenosphere position can mitigate notching by limiting hardware impingement [3–5], but may increase the forces required to abduct the arm [6]. Clinicians might optimize patient range of motion and function via implant placement if susceptibility to notching was known a-priori.

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

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.

Return to sport after reverse total shoulder arthroplasty is highly frequent: a systematic review

2021 ◽  
pp. jisakos-2020-000581
Author(s):  
Edoardo Franceschetti ◽  
Edoardo Giovannetti de Sanctis ◽  
Pietro Gregori ◽  
Alessio Palumbo ◽  
Michele Paciotti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Return To Sport ◽  
Rate Of Return ◽  
Return To Sports ◽  
The Mean ◽  
Reverse Total Shoulder ◽  
Subjective Level

ImportanceOne of the most frequent concerns of the increasing number of patients undergoing shoulder arthroplasty is the possibility to resume sport after surgery.ObjectiveThe aim of this systematic review was to determine the rate of return to sport after reverse total shoulder arthroplasty (RSA) and the subjective level of performance.Evidence reviewThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review. A systematic electronic search was performed using the PubMed (MEDLINE), Embase and Cochrane Library databases. All the studies analysing the rates were pooled; data were extracted and statistically analysed. The eligibility criteria were studies with at least 20 adult patients recruited. All studies had to relate return to sports after RSA.FindingsA total of six studies were included for a total of 457 patients. Mean age and average follow-up were, respectively, 74.7 years (range 33–88 years) and 3.6 years (range 1–9.4 years). The mean rate of return to sport ranged from 60% to 93%. The mean time for resuming sports was 5.3 months. The overall rate of return to sport after reverse shoulder arthroplasty was 79%. The mean level of sports at the time of the survey was worsened in 7.9%, improved in 39.6% and had no change in 55.2% of the cases.Conclusions and relevanceBased on the current available data, return to sports after reverse shoulder arthroplasty is possible and highly frequent. The subjective level of practice undergoes no change or improves in most of the cases. More studies and better-designed trials are needed in order to enrich the evidence on specific sports recovery after the procedure.Level of evidenceIV.

Surface Electromyography Reveals Middle Deltoid as The Functionally Dominant Shoulder Muscle After Reverse Total Shoulder Arthroplasty

2021 ◽  
Author(s):  
Emily Lau ◽  
Alexander Pietroski ◽  
Sreten Franovic ◽  
Yang Zhou ◽  
Noah Kuhlmann ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Muscle Activation ◽  
Total Shoulder Arthroplasty ◽  
Deltoid Muscle ◽  
Reverse Total Shoulder Arthroplasty ◽  
Shoulder Abduction ◽  
Shoulder Muscle ◽  
Significant Difference ◽  
Reverse Total Shoulder

Abstract Background: Reverse total shoulder arthroplasty (RSA) increases deltoid muscle fiber recruitment and tension to compensate for deficient rotator cuff activity; however, it is unclear whether the anterior or middle deltoid becomes dominant and how the muscle activation profile changes postoperatively. Using minimally invasive electromyography, this study evaluated the activity of the deltoid and surrounding muscles during shoulder motion to assess muscle activation changes post-RSA. Methods: In this observational study, we assessed change in preoperative to postoperative shoulder muscle activation in 10 patients over 6 months. Muscle activation was measured using 8 surface electrodes. Activation of the anterior, middle and posterior deltoid and surrounding muscles were recorded during shoulder abduction, flexion, external and internal rotation were quantified. One-way analysis of variance was used to identify significant differences in activation and time or speed. Least significant difference post hoc test was used to determine specific differences in muscle activation at subsequent time points. Results: RSA shoulders at 6 months postoperative showed a significant increase in activity of the middle deltoid predominantly. Middle deltoid activation increased during abduction (P < 0.001), flexion (P = 0.008), external (P < 0.001) and internal (P < 0.001) rotation. Conclusions: Our study demonstrates the middle deltoid predominates in rotator cuff function in RSA as defined by quantitative activation, significant involvement in all shoulder motions, and increased activation at subsequent times. These findings may help guide future RSA designs to optimize deltoid wrapping allowing for maximal strength and efficiency.

scholarly journals Bone grafting in primary and revision reverse total shoulder arthroplasty for the management of glenoid bone loss: A systematic review

2020 ◽  
Vol 20 ◽  
pp. 78-86 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
Dimitrios Chytas ◽  
Lazaros Kostretzis ◽  
Emmanouil Brilakis ◽  
Emmanouil Fandridis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Bone Grafting ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Glenoid Bone Loss ◽  
Reverse Total Shoulder

Optimal Screw Placement for Reverse Total Shoulder Arthroplasty

2010 ◽  
Author(s):  
Thuc-Quyen D. Nguyen ◽  
James Guido DiStefano ◽  
Andrew Y. Park ◽  
Gerd Diederichs ◽  
Jenni M. Buckley ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Glenoid Component ◽  
Catastrophic Failure ◽  
Bone Stock ◽  
Common Causes ◽  
Reverse Total Shoulder ◽  
Arthroplasty Surgery ◽  
Causes Of Failure

The reverse design of the total shoulder arthroplasty has been utilized for elderly patients with severely degenerated glenohumoral joints that are rotator cuff deficient. One of the most common causes of failure in shoulder arthroplasty involves loosening or catastrophic failure of the glenoid component. Such problems can be related to suboptimal fixation due to bone loss from fractures, severe degenerative changes and from previous failed arthroplasty surgery [1]. This emphasizes the need to secure the glenoid component with sound screw purchase beyond the glenoid vault. However, such fixation can often be tenuous as scapula bone quality is heterogeneous with a wide variation across short distances [2, 3]. Moreover, it can be difficult to identify regions with the best bone stock intraoperatively. This often requires multiple passes with the drill, which leads to further bone loss and potential decreased screw purchase. Thus, it is important for the surgeon to have a firm understanding of scapular anatomy with potential screw trajectories in mind.

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