Effect of Humeral Component Version on Outcomes in Reverse Shoulder Arthroplasty

Aleem, Alexander W.; Feeley, Brian T.; Austin, Luke; Benjamin, C.; Krupp, Ryan; Ramsey, Matthew L.; Getz, Charles L.

doi:10.3928/01477447-20170117-04

Cited by 27 publications

(13 citation statements)

References 18 publications

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“…Overall patient demographics of the three groups are described in Table 2. Seven studies with a total of 380 patients reported on RTSA where the humeral stem was implanted at less than 20 • of retroversion [14][15][16]24,27,28,30]. Of these studies, four were evidence level III, and three were level IV.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…There is a wide variation in practice as to the degrees of retroversion recreated, with biomechanical studies suggesting a compromise of avoiding scapular neck impingement by substituting a more anatomical version compared to increasing the range of motion, specifically external rotation, by implanting the stem in progressive degrees of retroversion [12,13]. Few clinical studies exist that have explicitly examined the effects of altering humeral stem version in RTSA on ROM and functional scores, with the current literature unable to show a distinct advantage of one particular version over another and no clear consensus from expert opinion [14][15][16].…”

Section: Introductionmentioning

confidence: 98%

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

Jassim¹,

Ernstbrunner

2021

JCM

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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.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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

Jassim¹,

Ernstbrunner

2021

JCM

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“…24 Humeral component retroversion has been explored in multiple studies. [25][26][27] Placing the humeral component in up to 20 retroversion increases the tension in the posterior rotator cuff and therefore may improve force for external rotation while not restricting internal rotation. This is important as maintaining good rotational forces following RSA is a major challenge.…”

Section: Resultsmentioning

confidence: 99%

Subscapularis in Reverse Total Shoulder Arthroplasty

Bigdon

Bolliger

Albers

2019

Journal of Shoulder and Elbow Arthroplasty

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The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly popular, but many biomechanical aspects are poorly understood. Particularly, the role and function of the subscapularis following RSA are unclear. Several clinical and biomechanical studies have analyzed its role in range of motion and stability. There is some evidence that the subscapularis is beneficial for stability but may reduce range of motion. This review provides an overview of the current literature, which suggests that the subscapularis may have a more important role in RSA than originally thought.

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“… 16 In this study, humeral retroversion did not affect shoulder elevation unlike previous studies. 1 , 12 , 37 …”

Section: Discussionmentioning

confidence: 99%

Three-dimensional kinematics of reverse shoulder arthroplasty: a comparison between shoulders with good or poor elevation

et al. 2021

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Background Various factors may be related to outcomes of reverse shoulder arthroplasty (RSA) including patient and surgical factors. Differences in shoulder kinematics might be associated with poor function after RSA; however, kinematic differences between shoulders with good or poor elevation have not been elucidated. The purpose of this study was to compare RSA kinematics between shoulders with good or poor elevation. Methods The study included 28 shoulders with a minimum 6-month follow-up after RSA using Grammont-type prostheses. Subjects comprised 17 men and 11 women with the mean age of 75 years (range, 63-91). Subjects underwent fluoroscopy during active scapular plane abduction. Computed tomography of their shoulders was performed to create 3-dimensional scapular implant models. Using model-image registration techniques, poses of 3-dimensional implant models were iteratively adjusted to match their silhouettes with the silhouettes in the fluoroscopic images, and 3-dimensional kinematics of implants were computed. Kinematics and glenosphere orientation were compared between shoulders with good (>90 degree) or poor (<90 degree) scapular plane abduction. Results Nineteen and 9 shoulders were assigned to the good- and poor-elevation groups, respectively. There were no significant differences between the groups in age, sex, height, weight, preoperative range of motion, or Constant score, but body mass index in the poor elevation shoulders was significantly larger than that in the good elevation shoulders. There were no significant differences in glenosphere (upward/downward rotation, anterior/posterior tilt, internal/external rotation) or glenohumeral (internal/external rotation, abduction/adduction) kinematics between the good and poor elevation shoulders. Scapulohumeral rhythm was significantly higher in the good elevation shoulders than the poor elevation shoulders ( P = .04). Glenosphere superior tilt was 2.3° ± 4.2° in the good-elevation group and 8.1° ± 8.9° in the poor-elevation group, and the difference was statistically significant ( P = .03). Discussion Shoulders with good elevation after RSA demonstrated better scapulohumeral rhythm than those with poor elevation, though there were no significant differences in glenosphere and glenohumeral kinematics. It may be important for better elevation to achieve good glenohumeral motion in shoulders with RSA. Glenosphere orientations may affect postoperative shoulder function.

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Effect of Humeral Component Version on Outcomes in Reverse Shoulder Arthroplasty

Cited by 27 publications

References 18 publications

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

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

Subscapularis in Reverse Total Shoulder Arthroplasty

Three-dimensional kinematics of reverse shoulder arthroplasty: a comparison between shoulders with good or poor elevation

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