Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes

Preuss, Fletcher R.; Fossum, Bradley W.; Peebles, Annalise M.; Eble, Stephanie K.

doi:10.1016/j.xrrt.2022.05.006

Cited by 1 publication

(1 citation statement)

References 41 publications

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“…It may be difficult or not possible to repair the subscapularis tendon in an implant with a LG/MH design, but it has been shown that this is not necessary for implant stability in an MG/LH prosthesis [40,49]. The need for repair of the subscapularis tendon after RTSA remains inconclusive at this time [39,40,49,50]. A meta-analysis by De Fine et al demonstrated no difference between the repair and non-repair groups.…”

Section: Mg/lhmentioning

confidence: 99%

The Influence of Reverse Total Shoulder Arthroplasty Implant Design on Biomechanics

Cogan

Entezari

et al. 2023

Curr Rev Musculoskelet Med

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Purpose of Review As reverse total shoulder arthroplasty indications have expanded and the incidence of its use has increased, developments in implant design have been a critical component of its success. The purpose of this review is to highlight the recent literature regarding the effect of implant design on reverse total shoulder arthroplasty biomechanics. Recent Findings Implant design for reverse total shoulder arthroplasty has evolved considerably from the modern design developed by Paul Grammont. The Grammont design had a medialized center of rotation and distalized humerus resulting from a 155° humeral neck shaft angle. These changes intended to decrease the forces on the glenoid component, thereby decreasing the risk for implant loosening and improving the deltoid moment arm. However, these features also led to scapular notching. The Grammont design has been modified over the last 20 years to increase the lateral offset of the glenosphere and decrease the prosthetic humeral neck shaft angle to 135°. These changes were made to optimize functional range of motion while minimizing scapular notching and improving active external rotation strength. Lastly, the introduction of preoperative planning and patient-specific instrumentation has improved surgeon ability to accurately place implants and optimize impingement-free range of motion. Summary Success and durability of the reverse total shoulder arthroplasty has been contingent upon changes in implant design, starting with the Grammont-style prosthesis. Current humeral and glenoid implant designs vary in parameters such as humeral and glenoid offset, humeral tray design, liner thickness, and neck-shaft angle. A better understanding of the biomechanical implications of these design parameters will allow us to optimize shoulder function and minimize implant-related complications after reverse total shoulder arthroplasty.

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