Reverse total shoulder arthroplasty: a biomechanical evaluation of humeral and glenosphere hardware configuration

Tashjian, Robert Z.; Burks, Robert T.; Zhang, Yue; Henninger, Heath B.

doi:10.1016/j.jse.2014.08.017

Cited by 45 publications

(15 citation statements)

References 47 publications

(97 reference statements)

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“…They found that glenosphere lateralization and humeral lengthening are both options to improve implant stability, and have a detrimental effect on overall deltoid force to abduction and joint loads. These data agree with previously published work showing that the deltoid force to abduct is larger with glenosphere lateralization of 10 mm as well as with humeral lengthening [4,6]. The current data support the idea that lateralization of the humerus reduces deltoid loads required for abduction, which to my knowledge, has never previously been reported, and is one of the major contributions of the current paper.…”

supporting

confidence: 93%

“…Humeral lateralization actually reduces deltoid force required for abduction and joint loads, as opposed to glenosphere lateralization or humeral lengthening. Biomechanically, the data suggests that glenosphere lateralization and increasing polyethylene insert thickness will improve stability at the cost of increased deltoid force required for abduction [4,6]. Clinically, it has been shown that glenophere lateralization can reduce notching and instability.…”

Section: Where Do We Need To Go?mentioning

confidence: 99%

“…With increased widespread use, numerous studies have been performed on how changes in its basic components affect the biomechanics and function of the implant. It is clear from several biomechanical studies [2][3][4][5][6] that placement of a reverse total shoulder arthroplasty lowers and medializes the center of rotation of the glenohumeral joint in comparision to the normal anatomic center of rotation. This effectively improves the deltoid moment arm reducing the overall loads to abduct the arm.…”

mentioning

confidence: 99%

See 2 more Smart Citations

CORR Insights®: Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Tashjian

2015

Clinical Orthopaedics &Amp; Related Research

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supporting

confidence: 93%

Section: Where Do We Need To Go?mentioning

confidence: 99%

mentioning

confidence: 99%

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CORR Insights®: Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Tashjian

2015

Clinical Orthopaedics &Amp; Related Research

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“…It would be expected that subscapularis repair would result in improved internal rotation and in a possible external rotation deficit. 23-25 However, only one study supported that the internal rotation was improved after subscapularis tenotomy and repair. 18 This study was also the only one to show that the passive external rotation was superior in the non-repair group.…”

Section: Discussionmentioning

confidence: 99%

Is subscapularis repair correlated with better outcome compared to non-repair in reverse total shoulder arthroplasty? A systematic review of comparative trials

Malahias¹,

Gerogiannis²,

Chronopoulos³

et al. 2019

Orthop Rev (Pavia)

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We aimed to investigate whether combined reverse total shoulder arthroplasty (RTSA) and subscapularis repair leads to improved clinical and functional outcome in comparison with RTSA alone. Two reviewers independently conducted a systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “reverse” AND “shoulder” AND “arthroplasty” AND “with” AND “subscapularis” AND “repair”. From the 72 initial studies, we finally chose five studies which were eligible to our inclusion-exclusion criteria. The total mean modified Coleman methodology test was 55/100 (range: 47/100 to 60/100). The eligible studies included 1087 patients, in total. Regarding the subjective functional scores as well as range of motion (ROM), the differences amongst groups were insignificant in almost all studies. The mean complications’ rate of the repair group was 10.4%, whereas the respective rate of the non-repair group was 10.2%. All studies concluded that the repair of subscapularis did not affect the complications’ rate of patients who were treated with RTSA. The mean dislocations’ rates of the repair and the non-repair group were 1.5% and 2.3%, respectively. Although subscapularis repair was proven safe and effective for the augmentation of RTSA, it did not offer any additional clinical or functional benefit in the outcome of patients treated with lateralized RTSA. Therefore, it is not supported its routine use for patients who have a preoperatively sufficient subscapularis tendon.

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“…However, these techniques have also shown drawbacks. Inferior tilting of the glenosphere can increase the tension on the deltoid and has also been shown to reduce the longevity of the implant [6,7]. Increasing the glenosphere arc or adding metal augment shifts the center of prosthesis rotation within the glenoid component and increases the unbalanced load on the glenoid component with each movement which can lead to early glenoid component loosening [8].…”

mentioning

confidence: 99%

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Tankshali¹,

Ji²,

Park³

et al. 2020

Preprint

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Background: Bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) was proposed which uses autograft harvested from the patient’s humeral head to lateralize the glenoid baseplate. This technique provided the lateralization of the center of rotation and the reduction of the scapular notching. Few studies have reported outcomes of BIO-RSA in the Asian population. We reported the first report of clinical and radiological outcomes of BIO-RSA in the Asian population at mid-term follow-up. Methods: From June 2012 to August 2017, a total 38 patients with average age of 73±6 years operated by the BIO-RSA technique with minimum two-year follow-up (average 36.7±16 months) were enrolled in our study. Indications of the BIO-RSA were rotator cuff tear arthropathy, massive irreparable cuff tear without osteoarthritis, primary osteoarthritis with glenoid defect, recurrent shoulder dislocation with massive cuff tear, and glenoid fracture sequela. We excluded patients with acute proximal humerus fracture, avascular necrosis and revision RSA performed using allo- or autograft. We evaluated clinical and radiological outcomes of BIO-RSA at the last follow-up. Results: VAS, ASES, UCLA, and SST scores improved significantly from preoperative (average-5, 39.4, 16.2, 3.9) to postoperative (average- 1.7, 78.9, 28.3, 7.8, p-value < 0.05). All range of motion except internal rotation improved significantly at the last follow-up (p-value <0.05) and the bone graft was incorporated with the native glenoid in all the cases (100%). However, scapular notching was observed in 23/38 (60.5%) of patients. Intraoperative complications were three metaphyseal fractures and one inferior screw malpositioning. Postoperative complications included one heterotropic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection. Conclusions: BIO-RSA results in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantage of glenoid lateralization were observed in our study along with similar complications rates as compared to conventional RTSA, we observed higher rates of scapular notching to previously reported rates in BIO-RSA studies.

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Reverse total shoulder arthroplasty: a biomechanical evaluation of humeral and glenosphere hardware configuration

Cited by 45 publications

References 47 publications

CORR Insights®: Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

CORR Insights®: Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Is subscapularis repair correlated with better outcome compared to non-repair in reverse total shoulder arthroplasty? A systematic review of comparative trials

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

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