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

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.

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Glenoid loosening and migration in reverse shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b4.bjj-2018-1275.r1 ◽

2019 ◽

Vol 101-B (4) ◽

pp. 461-469 ◽

Cited By ~ 6

Author(s):

A. Lädermann ◽

A. J. Schwitzguebel ◽

T. B. Edwards ◽

A. Godeneche ◽

L. Favard ◽

...

Keyword(s):

Conservative Treatment ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Multivariable Analysis ◽

Range Of Movement ◽

Original Cohort ◽

Glenoid Loosening

Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.

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Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b9.bjj-2018-0264.r1 ◽

2018 ◽

Vol 100-B (9) ◽

pp. 1182-1186 ◽

Cited By ~ 21

Author(s):

B. S. Werner ◽

J. Chaoui ◽

G. Walch

Keyword(s):

Internal Rotation ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Large Diameter ◽

Glenoid Component ◽

Range Of Movement ◽

Scapular Notching ◽

Component Size ◽

Centre Of Rotation

Aims Scapular notching is a frequently observed radiographic phenomenon in reverse shoulder arthroplasty (RSA), signifying impingement of components. The purposes of this study were to evaluate the effect of glenoid component size and glenosphere type on impingement-free range of movement (ROM) for extension and internal and external rotation in a virtual RSA model, and to determine the optimal configuration to reduce the incidence of friction-type scapular notching. Materials and Methods Preoperative CT scans obtained in 21 patients (three male, 18 female) with primary osteoarthritis were analyzed using modelling software. Two concurrent factors were tested for impingement-free ROM and translation of the centre of rotation: glenosphere diameter (36 mm vs 39 mm) and type (centred, 2 mm inferior eccentric offset, 10° inferior tilt). Results Glenosphere size was most predictive of increased extension and external rotation, whereas lateralization of the centre of rotation was the most predictive factor for internal rotation. A larger diameter of glenosphere combined with a 10° tilted configuration demonstrated superior values for extension and external rotation, whereas the eccentric component improved internal rotation by a mean 8.9° (standard deviation 2.7°) compared with a standard concentric glenosphere. Conclusion Glenosphere configuration can be modified to increase range of movement in RSA. Friction-type scapular notching was most effectively reduced by use of a large-diameter glenosphere with 10° inferior tilt. Cite this article: Bone Joint J 2018;100-B:1182–6.

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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

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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.

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Intrathoracic fracture-dislocation of the humeral head: A case report and review of the literature

10.32592/ircmj.2021.23.8.1248 ◽

2021 ◽

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Early Stage ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Multidisciplinary Treatment ◽

Fracture Dislocation ◽

Range Of Movement ◽

Multiple Fractures ◽

Emergency Thoracotomy

Background: Intrathoracic displacement of a humeral head fracture is extremely rare. Only slightly more than 30 cases have been reported in this regard. Since few cases have been reported, there is no consensus on how to treat this injury. The etiology, injury mechanism, related lesions, and treatment of the injury are diverse. Case presentation: A 73-year-old female presented with multiple fractures of the left ribs, bilateral lung contusions, extensive emphysema of the anterior and posterior chest wall, massive left hemopneumothorax, fracture-dislocation of the proximal humerus, and intrathoracic displacement of the humeral head. The patient was sent to the operating room for emergency thoracotomy surgery. The head of the humerus was confirmed to be completely removed from the thoracic cavity during the operation. After discussion with the orthopedic surgeon, the humeral head was discarded considering avascular necrosis; moreover, open reduction and internal fixation were not performed. The orthopedic surgery team performed reverse shoulder arthroplasty three weeks later. During follow-up, the patient’s shoulder was free from pain, and its range of movement included 110° flexion, 70° abduction, 35° external rotation, and 50° internal rotation. Conclusion: Intrathoracic displacement of the humeral head due to proximal humeral fracture is a very rare and serious trauma that requires multidisciplinary treatment. Considering the extremely high risk of humeral head necrosis, actively removing broken bone fragments of the humeral head in the early stage is recommended, and we advocate for shoulder arthroplasty for elderly patients. Detailed preoperative evaluations and individualized operation plans should be made to achieve the best effect.

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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.

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

Shoulder & Elbow ◽

10.1177/17585732211057887 ◽

2021 ◽

pp. 175857322110578

Author(s):

Ahmed Maksoud ◽

Colin Steinlechner ◽

Cheryl Baldwick ◽

William Tabi

Keyword(s):

Patient Outcomes ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Critical Shoulder Angle ◽

Radiological Parameters ◽

Predictive Parameters ◽

The Relationship ◽

Shoulder Angle

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.

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Can Lateralization of Reverse Shoulder Arthroplasty Improve Active External Rotation in Patients with Preoperative Fatty Infiltration of the Infraspinatus and Teres Minor?

Journal of Clinical Medicine ◽

10.3390/jcm10184130 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4130

Author(s):

Marko Nabergoj ◽

Shinzo Onishi ◽

Alexandre Lädermann ◽

Houssam Kalache ◽

Rihard Trebše ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Fatty Infiltration ◽

Postoperative Recovery ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Teres Minor

(1) Background: Postoperative recovery of external rotation after reverse shoulder arthroplasty (RSA) has been reported despite nonfunctional external rotator muscles. Thus, this study aimed to clinically determine the ideal prosthetic design allowing external rotation recovery in such a cohort. (2) Methods: A monocentric comparative study was retrospectively performed on patients who had primary RSA between June 2013 and February 2018 with a significant preoperative fatty infiltration of the infraspinatus and teres minor. Two groups were formed with patients with a lateral humerus/lateral glenoid 145° onlay RSA—the onlay group (OG), and a medial humerus/lateral glenoid 155° inlay RSA—the inlay group (IG). Patients were matched 1:1 by age, gender, indication, preoperative range of motion (ROM), and Constant score. The ROM and Constant scores were assessed preoperatively and at a minimum follow-up of two years. (3) Results: Forty-seven patients have been included (23 in OG and 24 in IG). Postoperative external rotation increased significantly in the OG only (p = 0.049), and its postoperative value was significantly greater than that of the IG by 11.1° (p = 0.028). (4) Conclusion: The use of a lateralized humeral stem with a low neck-shaft angle resulted in significantly improved external rotation compared to a medialized humeral 155° stem, even in cases of severe fatty infiltration of the infraspinatus and teres minor. Humeral lateralization and a low neck-shaft angle should be favored when planning an RSA in a patient without a functional posterior rotator cuff.

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EFEITOS DO DEEP RUNNING SOBRE A AMPLITUDE DE MOVIMENTO E A CAPACIDADE FUNCIONAL DOS MEMBROS SUPERIORES DE MULHERES MASTECTOMIZADAS: RELATO DE CASOS

Revista Científica JOPEF ◽

10.34059/ciejop.2019v27i1-11 ◽

2019 ◽

pp. 121-131

Keyword(s):

Range Of Motion ◽

Upper Limb ◽

Functional Capacity ◽

External Rotation ◽

Treatment Protocol ◽

Range Of Movement ◽

Flexion Extension ◽

Before And After ◽

In The Beginning ◽

And Function

Introduction: Breast cancer is the most common type of cancer among women in Brazil and in the worl. The surgical treatment procedure may cause severe morbidity in the upper limb homolateral to surgery, including the reduction of the range of motion, with consequent impairment of function. A physiotherapeutic approach has an important role in the recover range of motion and the functionality of these women, guaranteeing the occupational, domestestic, familiar and conjugated activities, and, in this way, also improving the quality of life. Objectives: To analyse chances in the shoulder's range of motion and the functional capacity of the upper limbs, promoted by the deep running procedure in women with late postoperative mastectomy. Methods: All the patients were submitted to an evaluation in the beginning and end of the treatment, including: goniometry of flexion, extension, abduction, adduction, internal and external rotation of the shoulder joint; and function capacity analysis in activities that involve the upper members by DASH questionnaire. The treatment protocol includes twelve sessions of deep running, realized twice a week, in deep pool, for 20-minute during six weeks. Results: Were submitted to treatment a total of 4 patients. Despite the improvement in the numerical values, statistically significant differences were not found on the range of movements and in the functional capacity of upper members before and after the deep running sessions in post-mastectomy women. Conclusion: Deep running had effects on the numerical values of range of movement and upper limb functionality in women in the late postoperative period of the mastectomy procedure, but without statistically significant differences.

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