Is subscapularis repair correlated with better outcome compared to non-repair in reverse total shoulder arthroplasty? A systematic review of comparative trials

We aimed to investigate whether combined reverse total shoulder arthroplasty (RTSA) and subscapularis repair leads to improved clinical and functional outcome in comparison with RTSA alone. Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “reverse” AND “shoulder” AND “arthroplasty” AND “with” AND “subscapularis” AND “repair”. From the 72 initial studies, we finally chose five studies which were eligible to our inclusion-exclusion criteria. The total mean modified Coleman methodology test was 55/100 (range: 47/100 to 60/100). The eligible studies included 1087 patients, in total. Regarding the subjective functional scores as well as range of motion (ROM), the differences amongst groups were insignificant in almost all studies. The mean complications’ rate of the repair group was 10.4%, whereas the respective rate of the non-repair group was 10.2%. All studies concluded that the repair of subscapularis did not affect the complications’ rate of patients who were treated with RTSA. The mean dislocations’ rates of the repair and the non-repair group were 1.5% and 2.3%, respectively. Although subscapularis repair was proven safe and effective for the augmentation of RTSA, it did not offer any additional clinical or functional benefit in the outcome of patients treated with lateralized RTSA. Therefore, it is not supported its routine use for patients who have a preoperatively sufficient subscapularis tendon.

Download Full-text

Functional Outcomes of Bilateral Reverse Total Shoulder Arthroplasty: A Systematic Review

Joints ◽

10.1055/s-0041-1730974 ◽

2021 ◽

Author(s):

Michael-Alexander Malahias ◽

Emmanouil Brilakis ◽

Dimitrios Chytas ◽

Dimitrios Gerogiannis ◽

Grigorios Avramidis ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Shoulder Arthroplasty ◽

Functional Outcomes ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Pubmed Database ◽

Functional Scores ◽

Reverse Total Shoulder

Abstract Purpose To answer the question whether bilateral reverse total shoulder arthroplasty (RTSA) is a safe and effective treatment which results in satisfactory clinical and functional outcomes with low complications rates. A second question to be answered was: what is the quality of the evidence of the already published studies which investigate the use of bilateral RTSA? Methods Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “reverse” AND “total” AND “shoulder” AND “arthroplasty” AND “clinical.” Descriptive statistics were used to summarize the data. Results From the 394 initial studies we finally selected and assessed 6 clinical studies which were eligible to our inclusion–exclusion criteria. The aforementioned studies included in total 203 patients (69% females; mean age range: 67.1–75 years; mean follow-up range: 12–61 months). From those, 168 patients underwent staged bilateral RTSA (mean duration between first and second operation range: 8–21.6 months) and the rest of them a unilateral RTSA as controlled treatment. Almost all mean clinical and functional scores, which were used to assess the therapeutic value of bilateral RTSA, depicted significant postoperative improvement in comparison with the mean preoperative values. The modified Coleman methodology score, which was used to assess the quality of the studies, ranged from a minimum of 36/100 to a maximum of 55/100. Conclusion Despite the lack of high-quality evidence, staged bilateral RTSA seems to be a safe and effective procedure for patients with cuff tear arthropathy, which results in significantly improved clinical and functional outcomes and low reoperations' rates. Level of Evidence Systematic review of level III-IV therapeutic studies.

Download Full-text

Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1280.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 761-766 ◽

Cited By ~ 25

Author(s):

M. Holschen ◽

M-K. Siemes ◽

K-A. Witt ◽

J. Steinbeck

Keyword(s):

Shoulder Arthroplasty ◽

Proximal Humeral Fracture ◽

Constant Score ◽

Total Shoulder Arthroplasty ◽

Operating Time ◽

Humeral Fracture ◽

Reverse Total Shoulder Arthroplasty ◽

The Mean ◽

Reverse Total Shoulder

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

Download Full-text

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

Journal of Clinical Medicine ◽

10.3390/jcm10245745 ◽

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.

Download Full-text

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

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-022-00625-y ◽

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.

Download Full-text

Reverse Shoulder Arthroplasty Versus Antegrade Nailing for 3- and 4-Part Proximal Humeral Fractures in Elderly Patients.

10.21203/rs.3.rs-73500/v1 ◽

2020 ◽

Author(s):

Khalil AMRI ◽

Rabie AYARI ◽

Karim LATRECH TLEMSANI ◽

Achraf ABDENNADHER ◽

Mohamed BEN SALAH ◽

...

Keyword(s):

Elderly Patients ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

The Elderly ◽

Reverse Total Shoulder Arthroplasty ◽

Complications Rate ◽

Reverse Total Shoulder

Abstract Introduction: Proximal humerus fractures are prevalent and widespread, accounting for 5% of all fractures, mainly in the elderly osteoporotic patients following a low-level trauma. Three-and four-part fractures represent 13 to 16% of these fractures and are generally associated with a worse prognosis. Depending on the fracture type and the patient status, several therapeutic options would be available ranging from osteosynthesis to arthroplasty. The aim of our study was to compare the functional and radiological results, as well as the complications of reverse shoulder arthroplasty and anterograde nailing when managing these fractures. Methods: A retrospective and descriptive study was conducted within the orthopedic surgery department of the Military Hospital of Instruction of Tunis, over a period of 42 months, from January 2016 to June 2019 with an average follow-up of 18 months. We included 31 cases of complex fractures of the proximal humerus in elderly patients, aged over 65 years, 16 of whom were treated by reverse total arthroplasty and 15 by antegrade nailing. Results: Our patient pool included 8 men and 23 women with a mean age of 73 years, ranging from 65 to 85. A low-energy fall was the main cause of the fractures with the dominant side being affected in 55% of cases. Four-part fractures were predominant representing 68% of the fractures. Constant and DASH scores at the last follow-up were at 68 and 24 respectively. Most patients were satisfied with the outcome of their surgeries, with an overall satisfaction rate of 87%. The complications rate was in accordance with the literature. Functional results in the group treated with reverse total shoulder arthroplasty were better with a lower complications rate. Conclusion: Reverse total shoulder arthroplasty has become an interesting surgical alternative, as the functional and anatomical results in our study were promising, while elucidating an improved quality of life for our patients. These findings have encouraged us to continue using this technique as a first-line choice for complex fractures of the proximal humerus in the elderly

Download Full-text

Intraoperative measurements of reverse total shoulder arthroplasty contact forces

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00311-0 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Kevin W. Farmer ◽

Masaru Higa ◽

Scott A. Banks ◽

Chih-Chiang Chang ◽

Aimee M. Struk ◽

...

Keyword(s):

Strain Gauge ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Contact Forces ◽

Average Weight ◽

Average Height ◽

The Mean ◽

Reverse Total Shoulder

Abstract Purpose Instability and fractures may result from tensioning errors during reverse total shoulder arthroplasty (RTSA). To help understand tension, we measured intraoperative glenohumeral contact forces (GHCF) during RTSA. Methods Twenty-six patients underwent RTSA, and a strain gauge was attached to a baseplate, along with a trial glenosphere. GHCF were measured in passive neutral, flexion, abduction, scaption, and external rotation (ER). Five patients were excluded due to wire issues. The average age was 70 (range, 54–84), the average height was 169.5 cm (range, 154.9–182.9), and the average weight was 82.7 kg (range, 45.4–129.3). There were 11 females and 10 males, and thirteen 42 mm and 8 38 mm glenospheres. Results The mean GHCF values were 135 N at neutral, 123 N at ER, 165 N in flexion, 110 N in scaption, and 205 N in abduction. The mean force at terminal abduction is significantly greater than at terminal ER and scaption (p < 0.05). Conclusions These findings could help reduce inappropriate tensioning.

Download Full-text

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

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219861446 ◽

2019 ◽

Vol 3 ◽

pp. 247154921986144 ◽

Cited By ~ 1

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.

Download Full-text

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

Shoulder & Elbow ◽

10.1177/17585732211013356 ◽

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.

Download Full-text

Clinically relevant results of reverse total shoulder arthroplasty for patients younger than 65 years compared to the older patients

Arthroplasty ◽

10.1186/s42836-021-00086-4 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Klaus Hanisch ◽

Michael Boelstoft Holte ◽

Inge Hvass ◽

Niels Wedderkopp

Keyword(s):

Quality Of Life ◽

Shoulder Arthroplasty ◽

Older Patients ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Group A ◽

The Mean ◽

Group B ◽

Reverse Total Shoulder

Abstract Background Reverse total shoulder arthroplasty was originally designed for older patients with rotator cuff arthropathy and produces good results. The main objective of this retrospective study was to compare the patients younger than 65 years vs. the older patients in terms of the complications of reverse total shoulder arthroplasty and the functional recovery. Methods From January 2014 to January 2020, 566 patients who underwent the reverse total shoulder arthroplasty were divided into two groups (group A, ≥ 65 years, n = 506; group B, < 65 years, n = 60). The patients reported the quality of life using the patient-reported Western Ontario Osteoarthritis of the Shoulder index. The Constant score was obtained preoperatively and 3 months postoperatively. The complications and reoperations were compared. Statistical significance was set at P < 0.05. Results Clinically relevant improvements were found in group A and B. There was a multivariate statistically-significant but not clinically relevant difference in the change over time between group A and B. The mean 12-month Western Ontario Osteoarthritis of the Shoulder indexes were 58 in group B and 71 in group A. The mean Constant scores were 44 in group B vs. 43 in group A. Compared to group A, group B had a non-significant odds ratio of 1.9, which did not reach the clinically relevant Western Ontario Osteoarthritis of the Shoulder index of group A. Conclusion In patients younger than 65 years of age, RTSA seems to be a safe procedure in short term follow-up. After 1 year, we found no increased risk of complications, revision, or inferior outcomes compared to patients older than 65 years of age. Consequently, after one-year, RTSA provided clinically relevant improvements in the patients’ quality of life and shoulder strength regardless of age.

Download Full-text

Os Acromiale in Reverse Total Shoulder Arthroplasty: A Cohort Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120965131 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096513

Author(s):

Guilherme Carpeggiani ◽

Sandro Hodel ◽

Tobias Götschi ◽

Philipp Kriechling ◽

Marco Bösch ◽

...

Keyword(s):

Cohort Study ◽

Range Of Motion ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Os Acromiale ◽

The Mean ◽

Matching Criteria ◽

Reverse Total Shoulder

Background: Increased passive deltoid tension after reverse total shoulder arthroplasty (RTSA) potentially leads to displacement or tilting of a preexisting os acromiale. Purpose: To analyze patients with an os acromiale who underwent RTSA and compare their outcomes and complications with a matched control group without an os acromiale. Study Design: Cohort study; Level of evidence, 3. Methods: In this study, 45 shoulders in 42 patients with an os acromiale (cases) were matched to 133 patients without os acromiale (controls) who underwent RTSA between 2005 and 2016. The mean follow-up was 52 ± 32 months. Matching criteria included sex, type of surgery, duration of follow-up, and age. The Constant score (CS), Subjective Shoulder Value (SSV), and radiological outcomes were assessed postoperatively at 1-year, 2-year, and final follow-up visits. Results: The mean CS, SSV, and range of motion improved from preoperative levels to the final follow-up in both groups ( P < .01). Patients with an os acromiale had a relative CS of 70 ± 23 versus 76 ± 21 points ( P = .15) and an SSV of 70 ± 30 versus 73 ± 24 ( P = .52) compared with controls at the final follow-up visit. Patients with an os acromiale had significantly decreased active flexion of 104° ± 33° versus 114° ± 33° ( P = .03) at 1 year and active abduction of 103° ± 37° versus 121° ± 38° at 2 years postoperatively ( P = .02). A postoperatively painful os acromiale was found in 12 cases (27%) and spontaneously resolved in 8 cases after a mean of 33 months (range, 12-47 months; P = .04). Conclusion: RTSA reliably restores patient satisfaction despite the presence of an os acromiale, with a slightly impaired range of motion. Postoperative local tenderness at the os acromiale can be expected in 1 out of 4 patients, but this resolves spontaneously over time in the majority of patients.

Download Full-text