Various radiological parameters have been measured in the Reverse Shoulder Arthroplasty (RSA) and correlated to patient outcomes, to determine best baseplate position. Results remain unclear with respect to certain parameters such as inferior baseplate tilt. We have investigated our series of patients to clarify the relationship between radiological parameters and patient outcomes.
Methods
We conducted a UK based bi-centre retrospective review of 156 prostheses. Critical shoulder angle (CSA), RSA angle (RSAA), Overhang and Deltoid Lever Arm (DLA) were measured on preoperative and postoperative radiographs. Range of motion and Oxford Shoulder Score (OSS) (range 1–8 years) were obtained. We assessed for scapular notching at minimum 1 year follow up (n = 138).
Results
Decreased postoperative CSA and increased DLA were associated with higher OSSs (P = 0.001 and 0.019). Increased overhang and DLA were associated with increased flexion (P = 0.033 and 0.024 respectively). Multivariate analysis showed that CSA and DLA affected notching rate (P = 0.002 and 0.007).
Conclusions
Baseplate tilt in relation to the acromion (CSA) and DLA are the most predictive parameters for notching and OSS. We recommend considering a maximum CSA of 26 degrees to decrease notching rate and improve OSS. We recommend considering an Overhang of at least 6 mm to improve FF.
BaulotESirveauxFBoileauP. Grammont's idea: the story of Paul Grammont's functional surgery concept and the development of the reverse principle. Clin Orthop Relat Res2011; 469: 2425–2431.
2.
LamFBhatiaDNMostofiSB, et al.Biomechanical considerations of the normal and rotator cuff deficient shoulders and the reverse shoulder prosthesis. Curr Orthop2007; 21: 40–46.
3.
SimovitchRWZumsteinMALohriE, et al.Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am2007; 89: 588–600.
4.
WerthelJ-DWalchGVegehanE, et al.Lateralization in reverse shoulder arthroplasty: a descriptive analysis of different implants in current practice. Int Orthop2019; 43: 2349–2360. DOI: 10.1007/s00264-019-04365-3
5.
DuethmanNCAibinderWRNguyenNTV, et al.The influence of glenoid component position on scapular notching. JSES Int2020; 4: 144–150.
6.
KemptonLBBalasubramaniamMAnkersonE, et al.A radiographic analysis of the effects of prosthesis design on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elbow Surg2011; 20: 571–576.
7.
BoileauPGauciM-OWagnerER, et al.The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty. J Shoulder Elbow Surg2019; 28: 1281–1290.
8.
FalaiseVLevigneCFavardL. Scapular notching in reverse shoulder arthroplasties: the influence of glenometaphyseal angle. Orthop Traumatol: Surg Res2011; 97: S131–S137.
9.
EdwardsTBTrappeyGJRileyC, et al.Inferior tilt of the glenoid component does not decrease scapular notching in reverse shoulder arthroplasty: results of a prospective randomized study. J Shoulder Elbow Surg2012; 21: 641–646.
10.
RheeS-MLeeJDParkYB, et al. Prognostic radiological factors affecting clinical outcomes of reverse shoulder arthroplasty in the Korean population. Clin Orthop Surg2019; 11: 112–119. 2019/02/18.
11.
FriedmanRJBarcelDAEichingerJK. Scapular notching in reverse total shoulder arthroplasty. J Am Acad Orthop Surg2019; 27(6): 200–209.
12.
HenningerHBKingFKTashjianRZ, et al.Biomechanical comparison of reverse total shoulder arthroplasty systems in soft tissue–constrained shoulders. J Shoulder Elbow Surg2014; 23: e108–e117.
13.
GreinerSSchmidtCHerrmannS, et al.Clinical performance of lateralized versus non-lateralized reverse shoulder arthroplasty: a prospective randomized study. J Shoulder Elbow Surg2015; 24: 1397–1404.
14.
RobersonTAShanleyEAbildgaardJT, et al.The influence of radiographic markers of biomechanical variables on outcomes in reverse shoulder arthroplasty. JSES Open Access2019; 3: 59–64.
15.
LädermannATayECollinP, et al.Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res2019; 8: 378–386.
16.
HaidamousGLädermannAHartzlerRU, et al.Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty. Shoulder Elbow2020; 29: E169.
17.
SuterTGerber PoppAZhangY, et al.The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg2015; 24: e149–e158.
18.
WernerBJacquotAMoléD, et al.Is radiographic measurement of acromiohumeral distance on anteroposterior view after reverse shoulder arthroplasty reliable?J Shoulder Elbow Surg2016; 25(9): e276–e280. DOI: 10.1016/j.jse.2016.02.017
19.
ValentiPSauzièresPKatzD, et al.Do less medialized reverse shoulder prostheses increase motion and reduce notching?Clin Orthop Relat Res2011; 469: 2550–2557.
20.
CuffDPupelloDViraniN, et al. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am2008; 90: 1244–1251. 2008/06/04.
21.
FrankleMSiegalSPupelloD, et al.The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a Minimum Two-year follow-up study of sixty patients. J Bone Joint Surg Am2005; 87(8): 1697–1705.
22.
VerdanoMAAlianiDGalavottiC, et al.Grammont versus lateralizing reverse shoulder arthroplasty for proximal humerus fracture: functional and radiographic outcomes. Musculoskelet Surg2018; 102: 57–65.
23.
KatzDValentiPKanyJ, et al.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. Int Orthop2016; 40: 99–108.
24.
HuriGFamiliariFSalariN, et al.Prosthetic design of reverse shoulder arthroplasty contributes to scapular notching and instability. World J Orthop2016; 7: 738–745.
25.
KemptonLBMDBalasubramaniamMMSAnkersonEBS, et al.A radiographic analysis of the effects of glenosphere position on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elbow Surg2011; 20: 968–974.
26.
LiXMDKnutsonZMDChoiDM, et al.Effects of glenosphere positioning on impingement-free internal and external rotation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg2013; 22: 807–813.
27.
RandelliPRandelliFArrigoniP, et al.Optimal glenoid component inclination in reverse shoulder arthroplasty. How to improve implant stability. Musculoskelet Surg2014; 98: 15–18.
28.
ChaeSWLeeJHanSH, et al.Inferior tilt fixation of the glenoid component in reverse total shoulder arthroplasty: a biomechanical study. Orthop Traumatol Surg Res2015; 101: 421–425.
29.
GutiérrezSMSGreiweRMMDFrankleMAMD, et al.Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg2007; 16: S9–S12.
30.
GutiérrezSPWalkerMMDWillisMMD, et al.Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model, validated by a mechanical model, of reverse shoulder arthroplasty. J Shoulder Elbow Surg2011; 20: 732–739.
31.
AibinderWRClarkNJSchochBS, et al.Assessing glenosphere position: superior approach versus deltopectoral for reverse shoulder arthroplasty. J Shoulder Elbow Surg2018; 27: 455–462.
32.
MahendrarajKAShieldsMVGrubhoferF, et al.Reassessing glenoid inclination in reverse total shoulder arthroplasty with glenosphere lateralization. Bone Joint J2021; 103–B: 360–365.
33.
YangC-CMDLuC-LMSWuC-HP, et al.Stress analysis of glenoid component in design of reverse shoulder prosthesis using finite element method. J Shoulder Elbow Surg2013; 22: 932–939.
34.
RocheCPMSStroudNJMSFlurinP-HMD, et al.Reverse shoulder glenoid baseplate fixation: a comparison of flat-back versus curved-back designs and oval versus circular designs with 2 different offset glenospheres. J Shoulder Elbow Surg2014; 23: 1388–1394.
35.
GoutallierDLe GuillouxPPostelJM, et al.Acromio humeral distance less than six millimeter: its meaning in full-thickness rotator cuff tear. Orthop Traumatol: Surg Res2011; 97: 246–251.
36.
LiveseyMHorneffJG3rd, et al.Functional outcomes and predictors of failure after rotator cuff repair during total shoulder arthroplasty. Orthopedics2018; 41: e334–e339. 2018/03/02.
37.
LévigneCGarretJBoileauP, et al. Scapular notching in reverse shoulder arthroplasty: is it important to avoid it and how?Clin Orthop Relat Res2011; 469: 2512–2520. 2010/12/01.
38.
BoileauPWatkinsonDJHatzidakisAM, et al.Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg2005; 14: S147–S161.
39.
de WildeLFPoncetDMiddernachtB, et al.Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthop2010; 81: 719–726.
40.
GrassiFAMurenaLValliF, et al.Six-Year experience with the Delta III reverse shoulder prosthesis. J Orthop Surg2009; 17: 151–156.
41.
RuggCMCoughlanMJLansdownDA. Reverse total shoulder arthroplasty: biomechanics and indications. Curr Rev Musculoskelet Med2019; 12: 542–553.
42.
WernerCMSteinmannPAGilbartM, et al. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am2005; 87: 1476–1486. 2005/07/05.
43.
F.SLFDO, et al.Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. J Bone Joint Surg Br2004; 86–B: 388–395.
44.
JangYHLeeJHKimSH. Effect of scapular notching on clinical outcomes after reverse total shoulder arthroplasty. Bone Joint J2020; 102–B: 1438–1445.
