The risk of postoperative scapular spine fracture following reverse shoulder arthroplasty is increased with an onlay humeral stem

Haidamous, Georges; Lädermann, Alexandre; Frankle, Mark A.; Gorman, R. Allen; Denard, Patrick J.

doi:10.1016/j.jse.2020.03.036

Cited by 62 publications

(34 citation statements)

References 26 publications

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“… 128 Clinically, distalization has been implicated as more of a culprit than lateralization. 129 Glenosphere lateralization has, further, a linear correlation with baseplate micromotion 130 and therefore exposes patients to the risk of aseptic loosening. 131 Giles et al tested the effect of glenoid and humeral lateralization on deltoid muscle load in vitro using a simulator.…”

Section: Reverse Shoulder Arthroplastymentioning

confidence: 99%

“… 155 , 156 Furthermore, lengthening via an onlay humeral component has been associated with an increased risk of acromial stress fracture compared to inlay components. 129 While there is no current consensus regarding the optimal way to increase soft tissue tension while avoiding complications, 144 , 157 recent biomechanical data suggest that humeral lateralization could potentially be a solution to improve joint and muscle loading. 132 , 158 , 159 However, one must keep in mind that humeral lateralization also leads to distalization.…”

Section: Reverse Shoulder Arthroplastymentioning

confidence: 99%

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Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm. More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014

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Section: Reverse Shoulder Arthroplastymentioning

confidence: 99%

Section: Reverse Shoulder Arthroplastymentioning

confidence: 99%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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“…This is potentially due to excessive tensioning of the deltoid muscle causing subsequent inferior stress on the acromion, weakening of the scapula through drill holes, and a lateralized glenosphere design. One potential risk factor for acromial or scapula spine fractures may be an increased humeral offset caused by implanting short stems with an onlay technique as recently described by Haidamous et al 24 However, we believe that positioning of the stem and inclination angle are important factors to compensate for these effects. It is concluded that scapula fractures are a general problem of RSA rather than a unique complication of short-stem RSA.…”

Section: Discussionmentioning

confidence: 84%

Primary reverse shoulder replacement with a short stem: A systematic literature review

Tross¹,

Woolson²,

Nolte³

et al. 2021

JSES Reviews, Reports, and Techniques

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Background: Total shoulder arthroplasty implant designs have continued to evolve over the years. One recent change has been the shortening of the humeral component to preserve bone stock and to facilitate revision surgery. Despite promising clinical results, radiographic bone adaptions occur frequently in short-stem total shoulder arthroplasty, and limited data exist on short-stem reverse shoulder arthroplasty (RSA). The purpose of this systematic review was to provide an overview about the functional and radiographic outcomes after an uncemented short-stem RSA, as well as identify areas of clinical importance that are underreported in the current literature. Methods: A systematic review of the literature was performed in accordance with the PRISMA guidelines using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Clinical outcome studies reporting on short-stem RSA outcomes with evidence level I-IV were included. Demographics, clinical and radiological outcomes, as well as complications and revision data were systematically analyzed and described. Results: Ten studies, published between 2014 and 2019, reporting on 555 shoulders with a mean followup of 32 months (range, 20-99.6 months) met the inclusion criteria. For all studies cuff tear arthropathy was the main indication for RSA (36%), followed by primary osteoarthritis (20%). Clinical outcome was reported in nine of ten studies, with range of motion improving in all studies. Six of the seven studies that used the Constant score (CS) demonstrated significant improvement (27.9 points to 69.3 points in weighted means). All studies reported on radiographic changes and bone adaptions. Among these, scapular notching was the most commonly observed (60 out of 327 cases, 18%) but without any described implication on clinical outcomes. No stem loosening was recorded at any final follow-up. A total of 63 complications (12.9%) were reported, with scapula fractures being the most commonly reported complication. Revision surgery was necessary in 24 cases (4.9%). Conclusion: Good clinical results, comparable with long-stem RSAs, are reported at short-term followup for short-stem RSAs. Humeral bone adaptions occur frequently but aseptic stem loosening is not a matter of concern at short-term follow-up. An area of clinical importance that is under-reported is the relation between filling ratio and stem alignment in short-stem RSA.

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“…As pinpointed by Haidamous et al [62], the risk might be related to an association of lateralization and distalization due to onlay designs. The authors concluded that increased postoperative distalization is associated with an increased risk of scapular spine fracture following RSA.…”

Section: Discussionmentioning

confidence: 95%

Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I—complications)

et al. 2021

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Background Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. Methods This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (01.01.2000–14.04.2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar employing several combinations of keywords: “reverse shoulder arthroplasty,” “reverse shoulder prosthesis,” “inverse shoulder arthroplasty,” “inverse shoulder prosthesis,” “problems,” “complications,” “results,” “outcomes,” “reoperation,” “revision.” Results Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with an overall reoperation rate of 1.7% and overall revision rate of 2.6%. Conclusions Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem in RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas short stems reported no humeral fractures or stem loosening. Infections (1.3%) proved to be the most common reason for component revision, and instability had a complication rate of 0.8%. Level of evidence Systematic review IV

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The risk of postoperative scapular spine fracture following reverse shoulder arthroplasty is increased with an onlay humeral stem

Cited by 62 publications

References 26 publications

Biomechanics of anatomic and reverse shoulder arthroplasty

Biomechanics of anatomic and reverse shoulder arthroplasty

Primary reverse shoulder replacement with a short stem: A systematic literature review

Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I—complications)

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