Inferior tilt of the glenoid leads to medialization and increases impingement on the scapular neck in reverse shoulder arthroplasty

Patel, Midhat; Martin, John R.; Campbell, David H.; Fernandes, Renan R.; Amini, Michael H.

doi:10.1016/j.jse.2020.09.023

Cited by 24 publications

(25 citation statements)

References 33 publications

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“…These declines improved ROM insignificantly concordant with previous results. 13,18,19 Furthermore, there was no significant difference in ROM and outcomes between superior, neutral, or inferior inclinations. Nevertheless, inferior inclination had the best results, coinciding with previous studies.…”

Section: Case Seriesmentioning

confidence: 83%

Clinico-radiological correlation of reverse shoulder arthroplasty outcomes

et al. 2022

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Positioning of prosthetic components is essential for the success and longevity of the prosthesis. Judging prosthetic implantation radiologically is always beneficial; plain radiographs and computed tomography can provide information regards inclination and version of glenoid component, besides, lateralization of prosthetic components. This study aims at postoperative radiological evaluation of component positioning of reverse shoulder prosthesis and correlating measured radiological parameters with clinical outcome. Radiological assessment was carried on by radiographs taking advantage of true anteroposterior projection, and midaxial two-dimensional computed tomography cut. Radiographs evaluated glenoid inclination in coronal plane (superior-inferior tilt) via global inclination angle, and critical shoulder angle. Center of rotation was evaluated by calculating acromion index. Additionally, acromiohumeral interval, and deltoid lever arm distance were documented. Midaxial CT cuts evaluated glenoid version. Each parameter was correlated to postoperative clinical outcome represented in range of motion and total functional scores. the mean acromion index revealed significant change to 63.82±9.06%, total medialization surged significantly with average 1.51 cm with a mean postoperative calibrated center of rotation-distance of 3.72±0.78 cm. The mean increase in acro-mio-humeral interval was 1.57 cm with a new postoperative value of 2.49±0.9 cm. The mean glenoid version declined to 5.7º±5º, however, this change was not significant. In conclusion, accurate positioning of shoulder prosthesis components with proper tensioning of soft tissue envelope within acceptable measurement parameters is considered crucial for stability and longevity of implant with the best clinical outcomes.

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Section: Case Seriesmentioning

confidence: 83%

Clinico-radiological correlation of reverse shoulder arthroplasty outcomes

et al. 2022

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“…Besides an inferior overhang, the glenosphere can be implanted with an inferior tilt, leading to further distalization and medialization of the center of rotation with a possible benefit for patients suffering from a rotator cuff tear arthropathy [ 81 ]. In a virtually supported cadaver study, Li et al reported the ideal glenosphere positioning in an inferior translation, inferior tilt, and lateralization in all degrees of scaption [ 82 ].…”

Section: Implant Designmentioning

confidence: 99%

The Evolution of Reverse Total Shoulder Arthroplasty—From the First Steps to Novel Implant Designs and Surgical Techniques

Frank

Siegert

Plachel

et al. 2022

JCM

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Purpose of Review: The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. Recent findings: Over the past decade, worldwide implantation rates of reverse total shoulder arthroplasty have drastically increased for various shoulder pathologies. While Paul Grammont’s design principles first published in 1985 for reverse total shoulder arthroplasty remained unchanged, several adjustments were made to address postoperative clinical and biomechanical challenges such as implant glenoid loosening, scapular notching, or limited range of motion in order to maximize functional outcomes and increase the longevity of reverse total shoulder arthroplasty. However, the adequate and stable fixation of prosthetic components can be challenging, especially in massive osteoarthritis with concomitant bone loss. To overcome such issues, surgical navigation and patient-specific instruments may be a viable tool to improve accurate prosthetic component positioning. Nevertheless, larger clinical series on the accuracy and possible complications of this novel technique are still missing.

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“…However, considering the normal anatomy of the glenoid with a 5° superior tilt and the superior wear of cuff tear arthropathy, a 10° inferior tilt of the baseplate is recommended to prevent scapular notching [32,33]. A glenosphere with an inferior offset (inferiorly overhanging glenosphere) can also be used for inferior translation of the glenoid component [34][35][36][37]. Several studies have shown that inferior overhang of the glenosphere provided a better range of motion (ROM) with a significantly lower rate of scapular notching [38][39][40][41].…”

Section: A a B Bmentioning

confidence: 99%

Implant selection for successful reverse total shoulder arthroplasty

Jeong

Won

2022

Clin Shoulder Elbow

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Reverse total shoulder arthroplasty (RTSA) emerged as a new concept of arthroplasty that does not restore normal anatomy but does restore function. It enables the function of the torn rotator cuff to be performed by the deltoid and shows encouraging clinical outcomes. Since its introduction, various modifications have been designed to improve the outcome of the RTSA. From the original cemented baseplate with peg or keel, a cementless baseplate was designed that could be fixed with central and peripheral screws. In addition, a modular-type glenoid component enabled easier revision options. For the humeral component, the initial design was an inlay type of long stem with cemented fixation. However, loss of bone stock from the cemented stem hindered revision surgery. Therefore, a cementless design was introduced with a firm metaphyseal fixation. Furthermore, to prevent complications such as scapular notching, the concept of lateralization emerged. Lateralization helped to maintain normal shoulder contour and better rotator cuff function for improved external/internal rotation power, but excessive lateralization yielded problems such as subacromial notching. Therefore, for patients with pseudoparalysis or with risk of subacromial notching, a medial eccentric tray option can be used for distalization and reduced lateralization of the center of rotation. In summary, it is important that surgeons understand the characteristics of each implant in the various options for RTSA. Furthermore, through preoperative evaluation of patients, surgeons can choose the implant option that will lead to the best outcomes after RTSA.

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Inferior tilt of the glenoid leads to medialization and increases impingement on the scapular neck in reverse shoulder arthroplasty

Cited by 24 publications

References 33 publications

Clinico-radiological correlation of reverse shoulder arthroplasty outcomes

Clinico-radiological correlation of reverse shoulder arthroplasty outcomes

The Evolution of Reverse Total Shoulder Arthroplasty—From the First Steps to Novel Implant Designs and Surgical Techniques

Implant selection for successful reverse total shoulder arthroplasty

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