Reverse shoulder arthroplasty-early results

Although reverse shoulder arthroplasty is used in massive rotator cuff tears, it is also used in proximal humerus fractures and shoulder arthroplasty revision. In this study, we aimed to examine the early radiological and clinical results of patients undergoing reverse shoulder arthroplasty with different diagnoses. Between 2010 and 2013, reverse shoulder arthroplasty was applied to 10 patients (4 men, 6 women) with the diagnosis of arthropathy due to rotator cuff tear (n: 7), multi-fragmentary proximal humerus fracture (n: 2) and hemiarthroplasty revision (n: 1). The median age of the patients was 74 (64-85) years and the median follow-up was 15.5 (3-35) months. Patients were assessed in terms of joint range of motion, Constant score and Visual Pain Scale (VAS) and radiological examinations before and after surgery. Preoperative active shoulder flexion, abduction, internal and external rotation degrees of the patients were 65, 30, 40 and 50 degrees, and 105, 95, 30, 57.5 degrees respectively in their final controls. Constant score was 20.5 (14-63) preoperatively, and 54.5 (38-64) in the final controls (p˂0.05). While the preoperative VAS was 7 (3-9), it was found to be 1.5 (1-3) in the final controls (p˂0.05). As a complication, scapular notching was observed in one patient. Internal external rotation values were better in the rotator cuff arthropathy group than the fracture group. Reverse shoulder arthroplasty, especially in the treatment of patients with rotator cuff arthropathy, has good early results and a low complication rate. We recommend paying attention to the glenoid component location to avoid scapular notching.

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Is limited external rotation after reverse shoulder arthroplasty associated with glenoidal notching?

Obere Extremität ◽

10.1007/s11678-021-00668-3 ◽

2021 ◽

Author(s):

Alexandra Grob ◽

Samy Bouaicha ◽

Marco Germann ◽

Sabra Germann ◽

Christian Gerber ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Radiographic Progression ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Cuff Tear ◽

Over Time

Abstract Background Reverse shoulder arthroplasty (RSA) is a valuable solution for patients with shoulder pain or injury primarily due to a rotator cuff tear or secondary to traumatic events. Nevertheless, several complications are known to appear, with the most frequent being scapular notching (SN) on the inferior and posterior scapular neck. Controversial data exist about the clinical relevance of SN. Since further consequences are still not clearly understood, we aimed to provide more clarity on which factors, especially external rotation (ER), contribute to the appearance and progress of notching. Methods Constant Score (CS), Subjective Shoulder Value (SSV), flexion, abduction, and ER were evaluated retrospectively in 153 shoulders of 147 patients (mean age 79±7.7 years; 62% women) who underwent RSA between 2005 and 2010. Anteroposterior radiographs were evaluated before and 1, 2, 3, and 5 years after RSA for SN according to the Sirveaux classification. The evaluation was performed by two independent surgeons. Spearman’s coefficient and t-test were used. Results CS, SSV, flexion, and abduction increased significantly 1 year after RSA compared to before (all p < 0.0001). No improvement was shown for ER between the same timepoints. Between 2 and 5 years of follow-up, only flexion decreased by 5°(p = 0.02) while CS, SSV, abduction, and ER remained constant. After RSA, notching increases over time. There was no association between SN and CS, SSV, flexion, abduction or ER at any of the measured timepoints. Higher flexion correlated with higher abduction after RSA at every follow-up (1 year r = 0.88, 2 years r = 0.89, 3 years r = 0.86, 5 years r = 0.86). The interrater correlation test showed a strong correlation (r = 0.7). Conclusion We verified the functional benefits of RSA for patients. Additionally, our findings show that despite radiographic progression of notching and unchanged limited ER, the postoperative improvements in CS, SSV, flexion, and abduction are preserved over 5 years.

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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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Reverse Shoulder Prosthesis With a Lateralized Glenosphere: Early Results of a Prospective Multicenter Study Stratified by Diagnosis

Journal of Shoulder and Elbow Arthroplasty ◽

10.1177/2471549219844040 ◽

2019 ◽

Vol 3 ◽

pp. 247154921984404 ◽

Cited By ~ 1

Author(s):

Samer S Hasan ◽

Jonathan C Levy ◽

Zachary R Leitze ◽

Avinash G Kumar ◽

Gary D Harter ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Multicenter Study ◽

Shoulder Arthroplasty ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Design Team ◽

Scapular Notching ◽

Cuff Tear ◽

Glenohumeral Arthritis

Background We report here on the results, stratified by diagnosis, of a multicenter prospective study by surgeons unaffiliated with the design team of reverse shoulder arthroplasty (RSA) performed using a lateralized glenosphere. We hypothesized that outcomes would be comparable to those reported previously.Methods: A total of 245 patients underwent RSA for cuff tear arthropathy or glenohumeral arthritis with rotator cuff tear, rotator cuff tear with instability or escape and without glenohumeral arthritis, or failed shoulder arthroplasty. Clinical, radiographic, and self-assessed outcome measures were obtained preoperatively and at standardized time points postoperatively. At 2 years, 173 patients were available as 23 patients were deceased, 12 had undergone revision, and 37 were unavailable.Results: Range of motion and outcomes improved, irrespective of diagnosis. Active forward flexion, abduction, and external rotation improved (73°–127°, 65°–109°, and 24°–37°, respectively, P < .0001 for all). Simple Shoulder Test (3.2–8.5) and American Shoulder and Elbow Surgeons scores (45–86) also improved. Scapular notching occurred in 13.3%; scapular spine/acromial fractures in 6.5%. Patients undergoing revision shoulder arthroplasty improved more modestly.Conclusion: In this multicenter study, surgeons unaffiliated with the design team obtained clinical improvements comparable to those reported previously and that exceeded minimal clinically important differences for RSA. Improvements in external rotation and low scapular notching rates potentially relate to the lateralized design.

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Fracture-Specific and Conventional Stem Designs in Reverse Shoulder Arthroplasty for Acute Proximal Humerus Fractures—A Retrospective, Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm10020175 ◽

2021 ◽

Vol 10 (2) ◽

pp. 175

Author(s):

Jan-Philipp Imiolczyk ◽

Philipp Moroder ◽

Markus Scheibel

Keyword(s):

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Bone Ingrowth ◽

External Rotation ◽

Reverse Shoulder Arthroplasty ◽

Proximal Humerus Fractures ◽

Stem Design ◽

Lesser Tuberosity ◽

Scapular Notching ◽

Humerus Fractures

Tuberosity healing and stem design can be outcome-dependent parameters in hemiarthroplasty for proximal humerus fractures (PHF). The relevance of fracture-specific stem design in reverse shoulder arthroplasty (RSA) is still a matter of debate. This retrospective study evaluates tuberosity healing and function for fracture specific stems (A) compared to conventional stems (B) in RSA for complex PHF in 26 patients (w = 21, mean age 73.5 years). Clinically, range of motion (ROM), Constant-Murley-Score (CS), Subjective Shoulder Value (SSV), and external rotation lag signs (ERLS) were evaluated. Healing of greater tuberosity (GT) and lesser tuberosity (LT), scapular notching, and loosening were examined radiologically. There were no statistical significant differences with regards to CS (A: 73 ± 11; B: 77 ± 9 points), SSV (A: 78% ± 11%; B: 84% ± 11%), external rotation (A: 18° ± 20°; B: 24° ± 19°), or internal rotation (A: 5.7 ± 2.2; B: 6.7 ± 2.8 CS-points) (p > 0.05). Mean forward flexion was superior for group A (p = 0.036). Consolidation of GT (82%) and LT (73%) was similar in both groups. Anatomical healing was slightly higher in group B (p > 0.05). Scapular notching was found in 27% (A) and 55% (B) (p > 0.05). RSA for PHF provides good to excellent clinical results. The quantitative and qualitative union rate for both cohorts was similar, indicating that fracture stems with open metaphyseal designs to allow for bone ingrowth do not improve tuberosity healing. ERLS correlates with a worse function in CS and ROM in all planes.

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Reverse shoulder arthroplasty for type 1 sequelae of a fracture of the proximal humerus

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0947.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 318-323 ◽

Cited By ~ 20

Author(s):

P. Raiss ◽

G. Alami ◽

T. Bruckner ◽

P. Magosch ◽

P. Habermeyer ◽

...

Keyword(s):

Rotator Cuff ◽

Proximal Humerus ◽

External Rotation ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Rotator Cuff Tears ◽

The Mean ◽

Rotator Cuff Deficiency

Aims The aim of this study was to analyze the results of reverse shoulder arthroplasty (RSA) in patients with type 1 sequelae of a fracture of the proximal humerus in association with rotator cuff deficiency or severe stiffness of the shoulder. Patients and Methods A total of 38 patients were included: 28 women and ten men. Their mean age at the time of arthroplasty was 73 years (54 to 91). Before the RSA, 18 patients had been treated with open reduction and internal fixation following a fracture. A total of 22 patients had a rotator cuff tear and 11 had severe stiffness of the shoulder with < 0° of external rotation. The mean follow-up was 4.3 years (1.5 to 10). The Constant score and the range of movement of the shoulder were recorded preoperatively and at final follow-up. Preoperatively, radiographs in two planes were performed, as well as CT or arthro-CT scans; radiographs were also performed at final follow-up. Results The mean Constant score improved from 25 points (5 to 47) preoperatively to 57 points (15 to 81) postoperatively. The mean forward elevation of the shoulder increased from 73° (10° to 130°) preoperatively to 117° (15° to 170°) postoperatively. Previous surgery did not influence the outcome. Patients with rotator cuff tears had lower Constant scores than patients without (p = 0.037). Those with preoperative stiffness of the shoulder had lower postoperative external rotation compared with patients without stiffness (p = 0.046). There was no radiographic evidence of loosening. Three complications occurred, leading to revision surgery in two patients. In all, 17 patients rated their result as very good (45%), another 17 as good (45%), two as satisfactory (5%), and two as unsatisfactory (5%). Discussion RSA is an effective form of treatment for patients with type 1 sequelae of a fracture of the proximal humerus associated with rotator cuff deficiency or stiffness of the shoulder, with high rates of satisfaction. Rotator cuff tears and stiffness of the shoulder had an adverse effect on the clinical outcome. Cite this article: Bone Joint J 2018;100-B:318–23.

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Reverse shoulder arthroplasty in complex fractures of the proximal humerus: results after 7 years of follow-up

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00597-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Alberto Izquierdo-Fernández ◽

Marta Gómez-Rodríguez ◽

Maite Urbano-Luque ◽

Manuel García-Carmona ◽

Rafael Quevedo-Reinoso ◽

...

Keyword(s):

Cohort Study ◽

Shoulder Arthroplasty ◽

Proximal Humerus ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Long Term Results ◽

First Year ◽

Level Of Evidence ◽

Cross Sectional ◽

Scapular Notching

Abstract Background There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. Material and methods A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. Results After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. Conclusions At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. Level of evidence III Controlled cohort study.

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Injury to the axillary and suprascapular nerves in rotator cuff arthropathy and after reverse shoulder arthroplasty: a prospective electromyographic analysis

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.12.030 ◽

2018 ◽

Vol 27 (7) ◽

pp. 1275-1282 ◽

Cited By ~ 8

Author(s):

Yaiza Lopiz ◽

Alberto Rodriguez-González ◽

Susana Martín-Albarrán ◽

Hector Marcelo ◽

Carlos García-Fernández ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Electromyographic Analysis ◽

Rotator Cuff Arthropathy

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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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