Improved Clinical Outcomes After Lateralized Reverse Shoulder Arthroplasty: A Systematic Review

Abstract

Background Lateralized reverse shoulder arthroplasty (RSA) has emerged as an attempt to improve on some of the drawbacks of conventional RSA, such as glenoid notching and decrease in ROM. Although this new design is being used in clinical practice, the evidence is mostly limited to case series and has not been systematically reviewed. Questions/purposes (1) How much did patient-reported outcome measures (PROMs) and ROM improve among patients who receive a lateralized RSA implant? (2) What proportion of shoulders experience complications, revision surgery, or scapular notching? Methods The PubMed and EMBASE databases were searched from database inception to January 31, 2020. We included clinical studies that reported the PROMs and/or ROM of patients with insufficient rotator cuffs undergoing RSA with a lateralized implant. All other types of studies

CORR Insights®: Improved Clinical Outcomes After Lateralized Reverse Shoulder Arthroplasty: A Systematic Review

“…Cuff et al [3], in their clinical series, found only 9% of shoulders demonstrated notching, and they observed 90% survivorship at 10-year follow-up with one lateralized design. In the current study, Nunes et al [8] help us understand that baseplate loosening, or pull-out, is not a concern, and at mid-term follow-up, lateral offset RTSA is a viable option. But we have yet to determine whether lateralized implants perform better than those with a medial center of rotation.…”

“…W. J. Warme ✉, University of Washington, Department of Orthopaedic Surgery, Seattle, WA98195-6500, USA, Email: warmewj@u. washington.edu with one lateralized design. In the current study, Nunes et al [8] help us understand that baseplate loosening, or pull-out, is not a concern, and at midterm follow-up, lateral offset RTSA is a viable option. But we have yet to determine whether lateralized implants perform better than those with a medial center of rotation.…”

“…In the current study, Nunes et al [8] conducted a systematic review to determine whether lateralized (RTSAs perform as advertised, in terms of acceptable complication, revision, and scapular notching rates. They included data on 1813 patients in the nine studies that met their inclusion criteria.…”

Update on Shoulder Arthroplasties with Emphasis on Imaging

“…Technetium-99 m three-phase bone scan imaging is sensitive for arthroplasty failure but is limited in determining the etiology [37,45].…”

“…The RTSA reverses the normal anatomy of the shoulder joint, replacing the glenoid component with a ball and replacing the humeral head with a socket. The reverse anatomy repositions the center of rotation and utilizes distalization of the humerus, thus restoring the tension of the deltoid muscle, which becomes the primary muscular force to move the shoulder [4,45]. The RTSA is a semi-constrained design which provides a stable fulcrum, as well as static stability and increased range of motion [45,60].…”