Reverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization

Jobin, Charles M.; Brown, Gabriel D.; Bahu, Maher J.; Gardner, Thomas R.; Bigliani, Louis U.; Levine, William N.; Ahmad, Christopher S.

doi:10.1016/j.jse.2011.08.049

Cited by 142 publications

(80 citation statements)

References 41 publications

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“…Finally with the 145°stem, AHD varied by 7 mm within the two extreme offset positions allowed by the humeral tray. Previous studies have shown that arm lengthening (reflected by AHD) is related to improvement in forward flexion following RSA with a Grammont style prosthesis [15,16]. The current study supports this concept as we observed a strong linear regression (R 2 = 0.961) between AHD and abduction.…”

Section: Discussionsupporting

confidence: 88%

Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty

Lädermann

Denard

Boileau³

et al. 2015

International Orthopaedics (SICOT)

166

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Purpose The impacts of humeral offset and stem design after reverse shoulder arthroplasty (RSA) have not been well-studied, particularly with regard to newer stems which have a lower humeral inclination. The purpose of this study was to analyze the effect of different humeral stem designs on range of motion and humeral position following RSA. Methods Using a three-dimensional computer model of RSA, a traditional inlay Grammont stem was compared to a short curved onlay stem with different inclinations (155°, 145°, 135°) and offset (lateralised vs medialised). Humeral offset, the acromiohumeral distance (AHD), and range of motion were evaluated for each configuration. Results Altering stem design led to a nearly 7-mm change in humeral offset and 4 mm in the AHD. Different inclinations of the onlay stems had little influence on humeral offset and larger influence on decreasing the AHD. There was a 10°decrease in abduction and a 5°increase in adduction between an inlay Grammont design and an onlay design with the same inclination. Compared to the 155°mod-el, the 135°model improved adduction by 28°, extension by 24°and external rotation of the elbow at the side by 15°, but led to a decrease in abduction of 9°. When the tray was placed medially, on the 145°model, a 9°loss of abduction was observed. Conclusions With varus inclination prostheses (135°and 145°), elevation remains unchanged, abduction slightly decreases, but a dramatic improvement in adduction, extension and external rotation with the elbow at the side are observed.

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Section: Discussionsupporting

confidence: 88%

Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty

Lädermann

Denard

Boileau³

et al. 2015

International Orthopaedics (SICOT)

166

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“…Half of the scapular notches are evolutive and are responsible for decreased function and greater risk of glenoid loosening [37]. To avoid this complication, many solutions have been proposed: bony lateralisation [3]; different techniques of baseplate implantation, such as a lower implantation, flush to the inferior rim of the glenoid cavity [4,38] and/or applying an inferior tilt [22,23,26,31]; modification of the shape of the glenosphere (eccentric [49] or oversized [10,49]); modification of the humeral-neck-shaft angle [33]. Some authors chose metallic lateralisation of the COR, which keeps the humeral bearing away from the pillar of the scapula.…”

Section: Introductionmentioning

confidence: 99%

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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Purpose Our purpose was to evaluate the influence of metallic lateralisation of the centre of rotation (COR) in reverse shoulder arthroplasty (RSA) on the incidence of scapular notching and its eventual clinical and radiological consequences. Methods We analysed 140 RSAs with a lateralised design (Arrow, FH Orthopedics, Mulhouse, France) implanted for massive rotator cuff tear with/without arthritis. Mean followup was 45 months (range 24-120, standard deviation 20). Patients were evaluated clinically using the Constant and Murley (Clin Orthop Relat Res 214:160-164, 1987) score and active range of motion (ROM) and radiologically using standard anteroposterior and axillary view. Scapular notching was assessed according to Sirveaux classification Simovitch et al. (J Bone Joint Surg Am, 89:588-600, 2007), and patients were separated into two groups (scapular notch/no scapular notch) and compared. Results Forty-one notches (29 %) were found: 20 grade 1, 18 grade 2, and three grade 3. The latter three patients had a follow-up of 44, 70 and 84 months, respectively, and the scapular notch did not evolve in the final two years. Better preoperative function was significantly associated with scapular notching (p<0,05 for flexion and abduction), but no final clinical differences in ROM and Constant score were found between groups. A body mass index (BMI) <30 increased the risk of scapular notching, which was observed in 43 % of patients with a BMI<30 and 30 % of patients with a BMI> 30 p=0,048). Pre-operative narrowing of the subacromial space increased the risk of scapular notching, but age or gender showed no influence. However, there was a significantly greater number of scapular notches in patients operated on the dominant side (p=0,04). No significant difference in lateral offset was found between groups (p=0,99). Glenoid implantation in an excessively high position (p=0,033) and absence of inferior tilt (p=0,0029) were significantly associated with scapular notching. Conclusions In this series, metallic lateralisation of the COR in RSA did not impair clinical results, with patients achieving good flexion recovery ROM increase in rotations. Metallic lateralisation of the COR in RSA leads to a lower incidence of scapular notching (29 %) compared with previously reported results using other arthroplastic systems with a more medialised COR. However, although scapular notching was not totally eliminated, those that were found did not evolve over time. Several factors increased the incidence of scapular notching: BMI <30, better preoperative ROM, an excessively high glenoid implant and absence of inferior tilt.

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“…Given that the RTSA increases the deltoid lever arm and reduces muscle effort for forward elevation and abduction [12,19], deltoid size and quality may not be as important for improved active elevation as appropriate deltoid lengthening. Other studies have established the association between deltoid lengthening and active forward elevation [2,15]. We did not assess deltoid lengthening and, therefore, cannot conclude whether it was associated with outcomes in this cohort.…”

Section: Discussionmentioning

confidence: 81%

Preoperative Deltoid Size and Fatty Infiltration of the Deltoid and Rotator Cuff Correlate to Outcomes After Reverse Total Shoulder Arthroplasty

Wiater

Koueiter

Maerz

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Reverse total shoulder arthroplasty (RTSA) allows the deltoid to substitute for the nonfunctioning rotator cuff. To date, it is unknown whether preoperative deltoid and rotator cuff parameters correlate with clinical outcomes. Questions/purposes We asked whether associations exist between 2-year postoperative results (ROM, strength, and outcomes scores) and preoperative (1) deltoid size; (2) fatty infiltration of the deltoid; and/or (3) fatty infiltration of the rotator cuff.Methods A prospective RTSA registry was reviewed for patients with cuff tear arthropathy or massive rotator cuff tears, minimum 2-year followup, and preoperative shoulder MRI. Final analysis included 30 patients (average age, 71 ± 10 years; eight males, 22 females). Only a small proportion of patients who received an RTSA at our center met inclusion and minimum followup requirements (30 of 222; 14%); however, these patients were found to be similar at baseline to the overall group of patients who underwent surgery in terms of age, gender, and preoperative outcomes scores. The cross-sectional area of the anterior, middle, and posterior deltoid was measured on axial proton density-weighted MRI. Fatty infiltration of the deltoid, supraspinatus, infraspinatus, teres minor, and subscapularis were quantitatively assessed on sagittal T1-weighted MR images. Patients were followed for ConstantMurley score, American Shoulder and Elbow Surgeons (ASES) scores, subjective shoulder value, pain, ROM, and strength. Correlations of muscle parameters with all outcomes measures were calculated. Results Preoperative deltoid size correlated positively with postoperative Constant-Murley score (67.27 ± 13.07) (q = 0.432, p = 0.017), ASES (82.64 ± 14.25) (q = 0.377; p = 0.40), subjective shoulder value (82.67 ± 17.89) (q = 0.427; p = 0.019), and strength (3.72 pounds ± 2.99 pounds) (q = 0.454; p = 0.015). Quantitative deltoid fatty infiltration (7.91% ± 4.32%) correlated

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Reverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization

Cited by 142 publications

References 41 publications

Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty

Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Preoperative Deltoid Size and Fatty Infiltration of the Deltoid and Rotator Cuff Correlate to Outcomes After Reverse Total Shoulder Arthroplasty

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