Influence of Glenosphere Design on Outcomes and Complications of Reverse Arthroplasty: A Systematic Review

Abstract

BackgroundDifferent implant designs are utilized in reverse shoulder arthroplasty. The purpose of this systematic review was to evaluate the results of reverse shoulder arthroplasty using a traditional (Grammont) prosthesis and a lateralized prosthesis for the treatment of cuff tear arthropathy and massive irreparable rotator cuff tears.MethodsA systematic review of the literature was performed via a search of two electronic databases. Two reviewers evaluated the quality of methodology and retrieved data from each included study. In cases where the outcomes data were similar between studies, the data were pooled using frequency-weighted mean values to generate summary outcomes.ResultsThirteen studies met the inclusion and exclusion criteria. Demographics were similar between treatment groups. The frequency-weighted mean active external rotation was 24° in the traditional group and 46° in the lateralized group (p = 0.0001). Scapular notching was noted in 44.9% of patients in the traditional group compared to 5.4% of patients in the lateralized group (p = 0.0001). The rate of clinically significant glenoid loosening was 1.8% in the traditional group and 8.8% in the lateralized group (p = 0.003).ConclusionsBoth the traditional Grammont and the lateralized offset reverse arthroplasty designs can improve pain and function in patients with diagnoses of cuff tear arthropathy and irreparable rotator cuff tear. While a lateralized design can result in increased active external rotation and decreased rates of scapular notching, there may be a higher rate of glenoid baseplate loosening.

Influence of glenosphere diameter and lateralization on instability of reverse shoulder arthroplasty

“…They found a significant increase of stress and displacement at the metaglene with increas-ing diameter of the glenosphere and with lateralization, while the stress increased more strongly with bony lateralization than with prosthetic lateralization. These studies support the clinical findings of the reports by Lawrence et al [22] and Helmkamp et al [16], as increased mechanical stress is a reasonable explanation for loosening and, ultimately, failure. Zumstein's group reported a significantly higher rate of aseptic loosening of the metaglene component in a lateralized implant compared to a medialized COR group [31].…”

“…garding complications or outcome scores were found, except for a higher metaglene loosening rate in the lateralized group. These results of Helmkamp's group basically confirmed the reported data from the systematic review of Lawrence et al from 2016 [22], who also reported better external rotation with less scapular notching. Notably, both reviews found a higher rate of metaglene loosening in the lateralized group [16,22], which is in accordance with basic research from Yang et al and Denard et al [8,30].…”

“…These results of Helmkamp's group basically confirmed the reported data from the systematic review of Lawrence et al from 2016 [22], who also reported better external rotation with less scapular notching. Notably, both reviews found a higher rate of metaglene loosening in the lateralized group [16,22], which is in accordance with basic research from Yang et al and Denard et al [8,30]. Yang et al investigated the effect of glenosphere diameter and eccentricity on shear forces acting on the metaglene baseplate in RSA [30].…”

Relationship Between Insertion Torque and Compression Strength in the Reverse Total Shoulder Arthroplasty Baseplate

“…One of the most common and devastating complications in RSA is glenoid baseplate failure. Frequency estimates in systematic reviews and large case series range from 1.8% to 10%, with most authors reporting rates of 5–9% for primary arthroplasty with higher rates for revision RSA . Initial fixation of non‐cemented implants is critical to achieve a stable bone‐to‐implant interface during the first few months after surgery to potentiate bone ingrowth and avoid aseptic loosening .…”

“…Frequency estimates in systematic reviews and large case series range from 1.8% to 10%, with most authors reporting rates of 5-9% for primary arthroplasty with higher rates for revision RSA. 1,[7][8][9][10][11][12][13][14][15] Initial fixation of non-cemented implants is critical to achieve a stable bone-to-implant interface during the first few months after surgery to potentiate bone ingrowth and avoid aseptic loosening. 3,[16][17][18] Minimization of micromotion to less than 150 µm between an implant and bone has been shown to be optimal in achieving a biological environment for bone growth onto metal arthroplasty surfaces.…”