Does isolated glenosphere lateralization affect outcomes in reverse shoulder arthroplasty?

King, Joseph J.; Hones, Keegan M.; Wright, Thomas W.; Roche, Christopher P.; Zuckerman, Joseph D; Schoch, Bradley S.

doi:10.1016/j.otsr.2022.103401

Cited by 8 publications

(4 citation statements)

References 48 publications

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“…By contrast, Berglund et al 15 reviewed 33 lateralized RSAs performed in patients with a preoperative ER deficit (active ER <0°) and at least 2 years of follow-up and found no relationship between teres minor atrophy and the restoration of ER. Other authors have corroborated Berglund's findings in patients with loss of ER, albeit non-CLEER patients, suggesting that lateralization alone is sufficient to restore ER 47,48 , while some studies (also non-CLEER) have found no difference in rotation with a lateralized RSA design 16,49 . In this study, mean postoperative ER was similar in lateralized and medialized RSA (23° vs. 20°; Fig.…”

Section: Discussionmentioning

confidence: 62%

“…The introduction of lateralized RSA designs has led some authors to suggest that tendon transfers are not necessary to restore ER in these deficient patients. While some authors have suggested that lateralization alone restores ER 15 , others were unable to demonstrate significant improvement in ER with a lateralized implant alone 16 . Proponents of tendon transfer have suggested that in the setting of an insufficient teres minor and infraspinatus, there is no possibility of generating sufficient torque for functional ER without a tendon transfer 13 .…”

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confidence: 99%

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Outcomes of Reverse Total Shoulder Arthroplasty with Latissimus Dorsi Tendon Transfer for External Rotation Deficit

Hones¹,

Rakauskas²,

Wright³

et al. 2023

JBJS Reviews

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Background: Latissimus dorsi transfer (LDT) has been purported to restore motion in patients undergoing reverse shoulder arthroplasty (RSA) who have preoperative combined loss of forward elevation (FE) and external rotation (ER). This systematic review summarizes the available evidence for the functional outcomes and complications after RSA with LDT. Furthermore, the effect of implant design and whether a concomitant teres major transfer (TMT) was performed were studied.Methods: A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We queried PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles reporting on LDT with RSA to restore ER. Our primary outcomes were ER, FE, Constant score, and complication incidence. Secondarily, we reported postoperative internal rotation (IR) and compared ER, FE, and Constant score based on lateralized versus medialized global implant design and whether concomitant TMT was performed.Results: Nineteen studies were evaluated; functional outcomes were assessed in 16 articles reporting on 258 RSAs (123 LDT, 135 LDT-TMT). Surgical indication was most commonly cuff tear arthropathy and massive irreparable cuff tear. Mean ER was 212°preoperatively and 25°postoperatively, FE was 72°preoperatively and 141°postoperatively. Mean postoperative Constant score was 65. Of 138 patients (8 studies) describing IR, only 25% reported a mean postoperative IR $L3. Subanalysis comparing lateralized versus medialized implants and whether TMT was concomitantly performed demonstrated no significant difference in postoperative ER, FE, and Constant score, nor preoperative to postoperative improvement in ER and FE. The complication rate was 14.1% (of 291 shoulders from 16 studies), including tear in the tendon transfer (n 5 3), revision tendon repair (n 5 1), nerve-related complication (n 5 9), and dislocation (n 5 9).Conclusions: RSA with LDT is a reliable option to restore motion, with a comparable complication rate with standard RSA. The use of medialized versus lateralized implants and whether the TM was concomitantly transferred may not influence clinical outcomes.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A974).

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Section: Discussionmentioning

confidence: 62%

mentioning

confidence: 99%

Outcomes of Reverse Total Shoulder Arthroplasty with Latissimus Dorsi Tendon Transfer for External Rotation Deficit

Hones¹,

Rakauskas²,

Wright³

et al. 2023

JBJS Reviews

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“…This was recently demonstrated in a multicenter clinical study including 61 female and 41 male patients undergoing RSA and receiving either a medialized or lateralized glenosphere. While the reported scapular notching rate was lower in the lateralized group, the incidence of SSFF was similar between groups [20].…”

Section: Discussionmentioning

confidence: 67%

A gender and size specific evaluation of inlay versus onlay stem designs in achieving lateralization and distalization in reverse shoulder arthroplasty

Imiolczyk,

Abu-Zeid,

Eckl

et al. 2024

Preprint

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Introduction: In reverse shoulder arthroplasty (RSA) new designs enable greater amounts of lateralization to prevent instability and scapular notching and increase range of motion, however, excessive lateralization leads to stress upon the acromion that can result in scapular spine fatigue fractures (SSFF). Aim of this study was to gender- and size-specifically assess the best implant design selection in order to reduce the risk of SSFF and to optimize lateralization, distalization, and bony impingement-free range of motion (ROM) in patients undergoing RSA. Methods: Computed tomography scans from 30 osteoarthritic patients (f:15, m:15) and 20 cuff tear arthropathy patients (f:10, m:10) were used to virtually simulate a RSA. The efficacy of inlay vs onlay stems combined with two glenospheres (36mm vs 42mm) in achieving ROM, lateralization, and distalization was evaluated. Moreover, gender and patients constitution were correlated to humeral size by radiologically measuring the best-fit circle of the humeral head. Results: A different amount of relative lateralization was achieved in both genders using large glenospheres and onlay designs. Latter yielded a higher ROM in all planes for men and women with a 42 mm glenosphere; with the 36mm glenosphere, an increased ROM was observed only in men. In women, this configuration only improved abduction. When adjusting the absolute amount of lateralization to humerus’ size and regardless of implant type, women received greater relative lateralization than men; with a 42mm glenosphere and an onlay system, women lateralized 19% vs 8.0% observed in men. Conclusion: The relative lateralization achieved using onlay design is much higher in women than men. Humeral lateralization using onlay designs should be used cautiously in women, as they may enhance the risk for developing SSFF. Our results point out that glenoid lateralization should be used instead to reduce inferior notching and to improve ROM, especially in small women. Level of Evidence: Basic Science Study, Computer Modeling

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“… 2 , 5 , 7 , 12 Additionally, adduction impingement is a well-known consequence of a medialized RSA design 6 , 8 , 14 , 24 and glenoid lateralization decreases scapular notching/adduction impingement. 15 , 21 …”

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confidence: 99%

Rates of subacromial notching are low following reverse shoulder arthroplasty with a 135° inlay humeral component and a lateralized glenoid

Pak,

Menendez,

Gobezie

et al. 2024

JSES International

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Does isolated glenosphere lateralization affect outcomes in reverse shoulder arthroplasty?

Cited by 8 publications

References 48 publications

Outcomes of Reverse Total Shoulder Arthroplasty with Latissimus Dorsi Tendon Transfer for External Rotation Deficit

Outcomes of Reverse Total Shoulder Arthroplasty with Latissimus Dorsi Tendon Transfer for External Rotation Deficit

A gender and size specific evaluation of inlay versus onlay stem designs in achieving lateralization and distalization in reverse shoulder arthroplasty

Rates of subacromial notching are low following reverse shoulder arthroplasty with a 135° inlay humeral component and a lateralized glenoid

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