scholarly journals Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty

2020 ◽  
Vol 102-B (11) ◽  
pp. 1438-1445
Author(s):  
Young Hoon Jang ◽  
Jeong Hyun Lee ◽  
Sae Hoon Kim
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Range Of Movement ◽  
Scapular Notching ◽  
Negative Effect ◽  
Reverse Total Shoulder

Aims Scapular notching is thought to have an adverse effect on the outcome of reverse total shoulder arthroplasty (RTSA). However, the matter is still controversial. The aim of this study was to determine the clinical impact of scapular notching on outcomes after RTSA. Methods Three electronic databases (PubMed, Cochrane Database, and EMBASE) were searched for studies which evaluated the influence of scapular notching on clinical outcome after RTSA. The quality of each study was assessed. Functional outcome scores (the Constant-Murley scores (CMS), and the American Shoulder and Elbow Surgeons (ASES) scores), and postoperative range of movement (forward flexion (FF), abduction, and external rotation (ER)) were extracted and subjected to meta-analysis. Effect sizes were expressed as weighted mean differences (WMD). Results In all, 11 studies (two level III and nine level IV) were included in the meta-analysis. All analyzed variables indicated that scapular notching has a negative effect on the outcome of RTSA . Statistical significance was found for the CMS (WMD –3.11; 95% confidence interval (CI) –4.98 to –1.23), the ASES score (WMD –6.50; 95% CI –10.80 to –2.19), FF (WMD –6.3°; 95% CI –9.9° to –2.6°), and abduction (WMD –9.4°; 95% CI –17.8° to –1.0°), but not for ER (WMD –0.6°; 95% CI –3.7° to 2.5°). Conclusion The current literature suggests that patients with scapular notching after RTSA have significantly worse results when evaluated by the CMS, ASES score, and range of movement in flexion and abduction. Cite this article: Bone Joint J 2020;102-B(11):1438–1445.

scholarly journals Clinical Outcomes and Joint Stability after Lateralized Reverse Total Shoulder Arthroplasty with and without Subscapularis Repair: A Meta-Analysis

2021 ◽  
Vol 10 (14) ◽  
pp. 3014
Author(s):  
Katia Corona ◽  
Simone Cerciello ◽  
Gianluca Ciolli ◽  
Lorenzo Proietti ◽  
Riccardo D'Ambrosi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Subscapularis Tendon ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Reverse Total Shoulder

Introduction: Subscapularis tendon repair in reverse total shoulder arthroplasty represents a potentially modifiable risk factor for dislocation, and its role continues to be debated. The purpose of the present meta-analysis was to compare the outcomes of the primary lateralized RSAs with and without subscapularis repair in terms of range of motion, clinical outcomes, dislocations, and complications rate. Materials and Methods: A systematic literature search in MEDLINE (Pubmed), Embase, and the Cochrane Central Register of Controlled Trials database was carried up to December 2020. A data extraction form was developed to collect select data from the included studies. The methodological quality was assessed using a Methodological Index for Nonrandomized Studies (MINORS) score. Statistical analysis was performed with Review Manager (Version 5.4, The Cochrane Collaboration). Results: A total of four comparative studies involving 978 patients were included. In the pooled analysis, the reinsertion of the subscapularis yielded better functional outcomes in terms of the constant (P < 0.00001) and ASES (P = 0.002) scores. The forward elevation, external rotation at 0°, internal rotation, and dislocation rates were comparable between the two groups (P = n.s.), while statistically increased abduction was observed in those patients who did not have their subscapularis repaired (P < 0.00001). Conclusion: The results of the present findings suggest that it seems reasonable to reinsert the subscapularis whenever it is present, in good tissue conditions, and with no evidence of fatty degeneration of its muscle belly. Level of evidence: Level III meta-analysis

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 Medialized versus Lateralized Center of Rotation in Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (24) ◽  
pp. 5868
Author(s):  
Alessandra Berton ◽  
Lawrence Vicent Gulotta ◽  
Umile Giuseppe Longo ◽  
Sergio De Salvatore ◽  
Ilaria Piergentili ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Cochrane Central Register ◽  
Complication Rates ◽  
Center Of Rotation ◽  
Humeral Component ◽  
Reverse Total Shoulder

One of the original biomechanical principles of reverse total shoulder arthroplasty (RTSA) is medialization of the center of rotation (COR) relative to the native level of the glenoid. Several authors have proposed the lateralized center of rotation, which is characterized by a lateralized (L) glenoid and medialized (M) humeral component. The aim of this review is to compare the clinical and functional outcomes of COR in medialized (M-RTSA) and lateralized (L-RTSA) RTSA in patients with uniform indications and treatment through a meta-analysis. A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Cochrane Clinical Answers was conducted from April to May 2021. Twenty-four studies were included in the qualitative synthesis, and 19 studies were included in the meta-analysis. Treatment with RTSA resulted in positive post-operative outcomes and low complication rates for both groups. Statistically relevant differences between L-RTSA group and M-RTSA group were found in post-operative improvement in external rotation with arm-at-side (20.4° and 8.3°, respectively), scapular notching rates (6.6% and 47.7%) and post-operative infection rates (1% and 7.7%). Both lateralized and medialized designs were shown to improve the postoperative outcomes. Nevertheless, a lateralized COR resulted in greater post-operative external rotation.

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.

Scapular Notching After Reverse Total Shoulder Arthroplasty

2018 ◽  
Vol 100 (13) ◽  
pp. 1095-1103 ◽  
Author(s):  
Joel Kolmodin ◽  
Iyooh U. Davidson ◽  
Bong Jae Jun ◽  
Nipun Sodhi ◽  
Naveen Subhas ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Scapular Notching ◽  
Reverse Total Shoulder

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 Clinical Predictors for Optimal Forward Elevation in Primary Reverse Total Shoulder Arthroplasty

2019 ◽  
Vol 3 ◽  
pp. 247154921983152
Author(s):  
David R Sollaccio ◽  
Joseph J King ◽  
Aimee Struk ◽  
Kevin W Farmer ◽  
Thomas W Wright
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Univariate Analysis ◽  
Reverse Total Shoulder Arthroplasty ◽  
Clinical Patient ◽  
Group I ◽  
Group Ii ◽  
Reverse Total Shoulder ◽  
Shoulder Elevation

Background Few studies in the literature analyze clinical factors associated with superoptimal and suboptimal forward elevation in primary reverse total shoulder arthroplasty (RTSA). We investigate the functional outcome stratified by shoulder elevation 12 months after primary RTSA and its correlation with selected clinical patient factors. Methods We analyzed prospectively collected data within a comprehensive surgical database on patients who had undergone primary RTSA between June 2004 and June 2013. Two hundred eighty-six shoulders were stratified into 2 groups: group I for shoulders that had achieved at least 145° of active forward elevation 12 months postoperatively (90th percentile of active forward elevation, 29 shoulders) and group II for shoulders that never achieved at least 90° of active forward elevation 12 months postoperatively (10th percentile of active forward elevation, 28 shoulders). Statistical analysis associated independent clinical variables with postoperative motion using univariate analysis followed by logistic regression. Results Active shoulder elevation of at least 90° was achieved 12 months postoperatively in 259 subjects (90%). Upon comparison with group II (<90° elevation), subjects in group I (≥145° elevation) were found to have improved postoperative active elevation and relatively younger age, lower American Society of Anesthesiologists score, increased preoperative active elevation, increased shoulder strength, increased passive elevation, decreased elevation lag, increased active and passive external rotation, and improved validated outcome scores. When assessing significant preoperative variables, the only independent predictor of improved postoperative forward elevation was preoperative active forward elevation. Conclusion These findings illuminate significant factors in the ability to achieve functional active shoulder elevation after primary RTSA. They may help surgeons appropriately counsel patients about anticipated functional prognosis following primary RTSA.

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