The clinical and radiographic impact of center of rotation lateralization in reverse shoulder arthroplasty: a systematic review

Helmkamp, Joshua; Bullock, Garrett S.; Amilo, Nnamdi R.; Guerrero, Evan M; Ledbetter, Leila; Sell, Timothy C.; Garrigues, Grant E.

doi:10.1016/j.jse.2018.07.007

Cited by 79 publications

(37 citation statements)

References 68 publications

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“…They found a significant increase of stress and displacement at the metaglene with increas-ing diameter of the glenosphere and with lateralization, while the stress increased more strongly with bony lateralization than with prosthetic lateralization. These studies support the clinical findings of the reports by Lawrence et al [22] and Helmkamp et al [16], as increased mechanical stress is a reasonable explanation for loosening and, ultimately, failure. Zumstein's group reported a significantly higher rate of aseptic loosening of the metaglene component in a lateralized implant compared to a medialized COR group [31].…”

Section: Discussionsupporting

confidence: 88%

“…These results of Helmkamp's group basically confirmed the reported data from the systematic review of Lawrence et al from 2016 [22], who also reported better external rotation with less scapular notching. Notably, both reviews found a higher rate of metaglene loosening in the lateralized group [16,22], which is in accordance with basic research from Yang et al and Denard et al [8,30]. Yang et al investigated the effect of glenosphere diameter and eccentricity on shear forces acting on the metaglene baseplate in RSA [30].…”

Section: Discussionsupporting

confidence: 76%

“…While biomechanical studies on the subject have shown measurable effects on joint load and improvement of joint stability [7,12,23], a systematic review of clinical studies by Helmkamp et al did not find significant differences in terms of dislocations and instability between lateralized and standard COR implants [16]. Summarizing the results, the authors reported improved external rotation and reduced scapular notching in the group of implants with lateralized COR.…”

Section: Discussionmentioning

confidence: 95%

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Influence of glenosphere diameter and lateralization on instability of reverse shoulder arthroplasty

et al. 2020

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Background Prosthetic replacement of the proximal humerus with reverse shoulder arthroplasty (RSA) is an established means of treatment. Due to its unique biomechanical characteristics, RSA can restore shoulder function to a satisfying level in the case of cuff tear arthropathy, arthritis, and fractures. However, complications are frequent in RSA, one of the more common being implant instability with dislocation. The present study investigated the influence of glenosphere diameter and metaglene lateralization using a unique test setup. Methods Seven fresh-frozen cadaveric specimens of the shoulder were thawed and dissected. The subscapularis muscle, the infraspinatus, and the three heads of the deltoid muscle were fixed to a pulley system. After implanting an RSA in different configurations (38/42 mm glenosphere with lateralization of +0 mm, +5 mm, or +10 mm), the implants were dislocated using selective muscle pull. The frequency of dislocations depending on the prosthesis configuration was documented. Results The larger glenosphere diameter of 42 mm showed less dislocations than the diameter of 38 mm (39 vs. 46). Lateralization of +0, +5 mm, and +10 mm showed 26, 29, and 30, dislocations, respectively. Dislocation via pull on the infraspinatus muscle was most frequent. None of the results reached statistical significance. Conclusion The current investigation used a novel technique for investigating the effect of lateralization and glenosphere diameter on RSA instability. Despite indicating tendencies, the present test setup could not prove the hypothesis that a larger glenosphere diameter and increased lateralization add to stability. The lack of statistical significance could be attributable to the low specimen number. The clinical significance of lateralization and glenosphere diameter should be further assessed in future biomechanical investigations.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 95%

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Influence of glenosphere diameter and lateralization on instability of reverse shoulder arthroplasty

et al. 2020

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“…5 A prior systematic review found no significant differences in postoperative outcomes between patients with medialized and lateralized COR implants. 27 Another prior retrospective study demonstrated significantly worse outcomes with lateralized implants. 30 Finally, a randomized clinical trial between a lateralization design and a medialized one demonstrated no significant differences in postoperative outcomes.…”

mentioning

confidence: 97%

Outcomes after a Grammont-style reverse total shoulder arthroplasty?

Tashjian

Hillyard

Childress

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The purpose of this study was to determine the factors associated with outcomes after reverse total shoulder arthroplasty (RTSA). Methods: We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We evaluated pain visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We evaluated preoperative and 2-week postoperative radiographs for glenoid inclination (GI), medialization as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance. We performed inter-and intrarater reliabilities via intraclass correlation coefficients (ICCs) and conducted a multivariable analysis. Results: We included 230 RTSAs in the analysis, with 70% follow-up at a median of 3.4 years. Reliability was acceptable with all ICCs >.678. Increased postoperative GI was significantly associated with increased VAS pain postoperatively (P ¼ .008). Increased distalization was associated with an increased rate of complications and reoperations (P ¼ .032). Younger age (P ¼ .008), female gender (P ¼ .009), and lower body mass index (BMI) (P ¼.006) were associated with worse ASES scores. Female gender (P <.001) and lower BMI (P ¼.039) were associated with worse SST scores. Female gender (P ¼ .013) and lower BMI (P ¼ .005) were associated with worse VAS-pain scores. Conclusion: Age, gender, and BMI are associated with outcome after RTSA. In this retrospective analysis of a Grammont-style RTSA, superior inclination is associated with increased pain postoperatively, whereas excessive arm lengthening is associated with increased risk for complication or reoperation.

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“…Among the various types of RTSA implants, lateralization of the humeral or glenoid component is currently used to minimize the complications associated with traditional medialized RTSA, including scapular notching and limitations in external and internal rotation. 19 Biomechanically, lateralization of the glenoid component may decrease scapular notching and impingement of shoulder motion, and lateralization of the humeral component can preserve a more anatomic position of the greater tuberosity of the humerus and enhance compressive forces by increasing the abductor lever arm and deltoid wrapping. 30 , 43 Therefore, a direct comparison of the clinical outcomes of RTSA with a humeral-lateralization design between CTA with an altered humeral position and an ICT with preserved anatomic alignment might provide reliable information for determining the difference in the effectiveness of RTSA for both diseases.…”

mentioning

confidence: 99%

Clinical comparison of humeral-lateralization reverse total shoulder arthroplasty between patients with irreparable rotator cuff tear and patients with cuff tear arthropathy

Lee¹,

Chun²,

Kim³

et al. 2020

JSES International

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Background This study aimed to compare the clinical and radiologic outcomes between patients with irreparable cuff tears (ICTs) and those with cuff tear arthropathy (CTA) after reverse total shoulder arthroplasty (RTSA) with a humeral-lateralization prosthesis. Methods A total of 127 patients with ICTs and CTA who underwent RTSA were enrolled and matched at a 1:2 ratio by propensity score. Preoperative shoulder function was assessed for all patients. Radiologic parameters including the acromion–deltoid tuberosity (ADT) distance, lateral humeral offset, and scapular notching were evaluated. Results Thirty-four patients in the ICT group and 68 patients in the CTA group were matched for comparison. Preoperatively, mean active forward flexion in the ICT group (89.7° ± 29.4°) was significantly better than that in the CTA group (65.5° ± 24.0°, P < .001). In the CTA group, fatty infiltration of the supraspinatus was worse (3.7 ± 0.5) and the ADT distance was shorter (134.0 ± 12.0 mm) compared with the ICT group preoperatively (3.3 ± 0.8 [ P = .008] and 140.7 ± 12.5 mm [ P = .001], respectively). There was no significant difference in postoperative functional or radiologic outcomes between the 2 groups. However, gains in active forward flexion (37.9° in ICT group vs. 61.5° in CTA group, P < .01) and abduction (42.1° in ICT group vs. 60.6° in CTA group, P < .01) were significantly greater in the CTA group than in the ICT group. Conclusions Shoulder function was significantly improved after RTSA regardless of the preoperative diagnosis. Postoperatively, radiologic findings were not significantly different between the 2 groups. Due to the fact that preoperative range of motion and rotator cuff status were better in patients with ICTs, improvements in active forward flexion and abduction were significantly greater in patients with CTA.

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The clinical and radiographic impact of center of rotation lateralization in reverse shoulder arthroplasty: a systematic review

Cited by 79 publications

References 68 publications

Influence of glenosphere diameter and lateralization on instability of reverse shoulder arthroplasty

Influence of glenosphere diameter and lateralization on instability of reverse shoulder arthroplasty

Outcomes after a Grammont-style reverse total shoulder arthroplasty?

Clinical comparison of humeral-lateralization reverse total shoulder arthroplasty between patients with irreparable rotator cuff tear and patients with cuff tear arthropathy

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