Treating cuff tear arthropathy by reverse total shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical and the radiological outcome?
Purpose Reverse total shoulder arthroplasty is widely used for the treatment of cuff tear arthropathy. Standard implants consist of a humeral component with an inclination angle of 155° and a glenosphere without lateral offset. Recently, lower inclination angles of the humeral component as well as l...
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| Veröffentlicht in: | European journal of orthopaedic surgery & traumatology 2022-02, Vol.32 (2), p.307-315 |
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| creator | Holschen, Malte Kiriazis, Alexandros Bockmann, Benjamin Schulte, Tobias L. Witt, Kai-Axel Steinbeck, Jörn |
| description | Purpose
Reverse total shoulder arthroplasty is widely used for the treatment of cuff tear arthropathy. Standard implants consist of a humeral component with an inclination angle of 155° and a glenosphere without lateral offset. Recently, lower inclination angles of the humeral component as well as lateralized glenospheres are implanted to provide better rotation of the arm and to decrease the rate of scapular notching. This study investigates the clinical and radiological results of a standard reverse total shoulder in comparison with an implant with an inclination angle of 135° in combination with a 4 mm lateralized glenosphere in context of cuff tear arthropathy.
Material and methods
For this retrospective comparative analysis 42 patients treated by reverse total shoulder arthroplasty for cuff tear arthropathy were included. Twenty-one patients (
m
= 11,
f
= 10; mean age 76 years; mean follow-up 42 months) were treated with a standard 155° humeral component and a standard glenosphere with caudal eccentricity (group
A
), while twenty-one patients (
m
= 5,
f
= 16; mean age 72 years; mean follow-up 34 months) were treated with a 135° humeral component and 4 mm lateral offset of the glenosphere (group
B
). At follow-up patients of both groups were assessed with plain X-rays (a.p. and axial view), Constant Score, adjusted Constant Score, the subjective shoulder value and the range of motion.
Results
The clinical results were similar in both groups concerning the Constant Score (group
A
= 56.3 vs. group
B
= 56.1;
p
= 0.733), the adjusted CS (group
A
= 70.4% vs. group
B
= 68.3%;
p
= 0.589) and the SSV (group
A
= 72.0% vs. group
B
= 75.2%;
p
= 0.947). The range of motion of the operated shoulders did not differ significantly between group
A
and group
B
: Abduction = 98° versus 97.9°,
p
= 0.655; external rotation with the arm at side = 17.9° versus 18.7°,
p
= 0.703; external rotation with the arm positioned in 90° of abduction = 22.3° versus 24.7°,
p
= 0.524; forward flexion = 116.1° versus 116.7°,
p
= 0.760. The rate of scapular notching was higher (
p
= 0.013) in group
A
(overall: 66%, grade 1: 29%, grade 2: 29%, grade 3: 10%, grade 4: 0%) in comparison to group
B
(overall: 33%, grade 1: 33%, grade 2: 0%, grade 3: 0%, grade 4: 0%). Radiolucency around the humeral component was detected in two patients of group B. Stress shielding at the proximal humerus was observed in six patients of Group
A
(29%; cortical thinning and osteopenia in zone M1 a |
| doi_str_mv | 10.1007/s00590-021-02976-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2516223446</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2516223446</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-9e3b963b89c1e8f93598d18e267e82d89e0fb8b781ed817228d4cdb734a02c0c3</originalsourceid><addsrcrecordid>eNp9kU2L1TAYhYsozjj6B1xIwI2baj76kbgRGfyCATfjOqTJm9sOaVKTVLg_039k2jt3BBcuQsJ7nnPewKmqlwS_JRj37xLGrcA1pqQc0Xd186i6JA2jNcEdf1zeHWM1x117UT1L6Q5j0grSPq0uGOPbuLmsft9GUHnyB6RXa1EGFZGKeYxhUXk8ouGIIvyCmADlkJVDaQyrM_BAOZXy8T0yAeUR0OS1m3wJDB4Fu4_GdYZYjDrMS_DgM1Le7IpTeVeCtQnymT848CEtI8QtzroVvIZd2aInXQzngKjMFFw47MOw5rICPjyvnljlEry4v6-qH58_3V5_rW--f_l2_fGm1qxvcy2ADaJjAxeaALeCtYIbwoF2PXBquABsBz70nIDhpKeUm0aboWeNwlRjza6qN6fcJYafK6Qs5ylpcE55CGuStCUdpaxpuoK-_ge9C2v05XeSdpQI2lCyUfRE6RhSimDlEqdZxaMkWG6Fy1PhshQu98JlU0yv7qPXYQbzYDk3XAB2AlKR_AHi393_if0DUBy7Lw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2621924216</pqid></control><display><type>article</type><title>Treating cuff tear arthropathy by reverse total shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical and the radiological outcome?</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Holschen, Malte ; Kiriazis, Alexandros ; Bockmann, Benjamin ; Schulte, Tobias L. ; Witt, Kai-Axel ; Steinbeck, Jörn</creator><creatorcontrib>Holschen, Malte ; Kiriazis, Alexandros ; Bockmann, Benjamin ; Schulte, Tobias L. ; Witt, Kai-Axel ; Steinbeck, Jörn</creatorcontrib><description>Purpose
Reverse total shoulder arthroplasty is widely used for the treatment of cuff tear arthropathy. Standard implants consist of a humeral component with an inclination angle of 155° and a glenosphere without lateral offset. Recently, lower inclination angles of the humeral component as well as lateralized glenospheres are implanted to provide better rotation of the arm and to decrease the rate of scapular notching. This study investigates the clinical and radiological results of a standard reverse total shoulder in comparison with an implant with an inclination angle of 135° in combination with a 4 mm lateralized glenosphere in context of cuff tear arthropathy.
Material and methods
For this retrospective comparative analysis 42 patients treated by reverse total shoulder arthroplasty for cuff tear arthropathy were included. Twenty-one patients (
m
= 11,
f
= 10; mean age 76 years; mean follow-up 42 months) were treated with a standard 155° humeral component and a standard glenosphere with caudal eccentricity (group
A
), while twenty-one patients (
m
= 5,
f
= 16; mean age 72 years; mean follow-up 34 months) were treated with a 135° humeral component and 4 mm lateral offset of the glenosphere (group
B
). At follow-up patients of both groups were assessed with plain X-rays (a.p. and axial view), Constant Score, adjusted Constant Score, the subjective shoulder value and the range of motion.
Results
The clinical results were similar in both groups concerning the Constant Score (group
A
= 56.3 vs. group
B
= 56.1;
p
= 0.733), the adjusted CS (group
A
= 70.4% vs. group
B
= 68.3%;
p
= 0.589) and the SSV (group
A
= 72.0% vs. group
B
= 75.2%;
p
= 0.947). The range of motion of the operated shoulders did not differ significantly between group
A
and group
B
: Abduction = 98° versus 97.9°,
p
= 0.655; external rotation with the arm at side = 17.9° versus 18.7°,
p
= 0.703; external rotation with the arm positioned in 90° of abduction = 22.3° versus 24.7°,
p
= 0.524; forward flexion = 116.1° versus 116.7°,
p
= 0.760. The rate of scapular notching was higher (
p
= 0.013) in group
A
(overall: 66%, grade 1: 29%, grade 2: 29%, grade 3: 10%, grade 4: 0%) in comparison to group
B
(overall: 33%, grade 1: 33%, grade 2: 0%, grade 3: 0%, grade 4: 0%). Radiolucency around the humeral component was detected in two patients of group B. Stress shielding at the proximal humerus was observed in six patients of Group
A
(29%; cortical thinning and osteopenia in zone M1 and L1) and two patients of group
B
(10%; cortical thinning and osteopenia in zone M1 and L1). Calcifications of the triceps origin were observed in both groups (group
A
= 48% vs. group
B
= 38%).
Conclusion
Theoretically, a lower inclination angle of the humeral component and an increased lateral offset of the glenosphere lead to improved impingement-free range of motion and a decreased rate of scapular notching, when compared to a standard reverse total shoulder implant. This study compared two different designs of numerous options concerning the humeral component and the glenosphere. In comparison to a standard-fashioned implant with a humeral inclination of 155° and a standard glenosphere, implants with a humeral inclination angle of 135° and a 4 mm lateralized glenosphere lead to comparable clinical results and rotatory function, while the rate of scapular notching is decreased by almost 50%. While the different implant designs did not affect the clinical outcome, our results indicate that a combination of a lower inclination angle of the humeral component and lateralized glenosphere should be favored to reduce scapular notching.
Level of evidence
Level III, retrospective comparative study</description><identifier>ISSN: 1633-8065</identifier><identifier>EISSN: 1432-1068</identifier><identifier>DOI: 10.1007/s00590-021-02976-4</identifier><identifier>PMID: 33880654</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>Aged ; Arthroplasty, Replacement, Shoulder ; Humans ; Humerus - surgery ; Joint replacement surgery ; Joint surgery ; Medicine ; Medicine & Public Health ; Original Article ; Prosthesis Design ; Range of motion ; Range of Motion, Articular ; Retrospective Studies ; Rotator Cuff Tear Arthropathy - surgery ; Shoulder ; Shoulder Joint - diagnostic imaging ; Shoulder Joint - surgery ; Shoulder Prosthesis ; Surgical Orthopedics ; Transplants & implants ; Traumatic Surgery</subject><ispartof>European journal of orthopaedic surgery & traumatology, 2022-02, Vol.32 (2), p.307-315</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2021</rights><rights>2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-9e3b963b89c1e8f93598d18e267e82d89e0fb8b781ed817228d4cdb734a02c0c3</citedby><cites>FETCH-LOGICAL-c375t-9e3b963b89c1e8f93598d18e267e82d89e0fb8b781ed817228d4cdb734a02c0c3</cites><orcidid>0000-0002-7293-2224</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00590-021-02976-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00590-021-02976-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27902,27903,41466,42535,51296</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33880654$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Holschen, Malte</creatorcontrib><creatorcontrib>Kiriazis, Alexandros</creatorcontrib><creatorcontrib>Bockmann, Benjamin</creatorcontrib><creatorcontrib>Schulte, Tobias L.</creatorcontrib><creatorcontrib>Witt, Kai-Axel</creatorcontrib><creatorcontrib>Steinbeck, Jörn</creatorcontrib><title>Treating cuff tear arthropathy by reverse total shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical and the radiological outcome?</title><title>European journal of orthopaedic surgery & traumatology</title><addtitle>Eur J Orthop Surg Traumatol</addtitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><description>Purpose
Reverse total shoulder arthroplasty is widely used for the treatment of cuff tear arthropathy. Standard implants consist of a humeral component with an inclination angle of 155° and a glenosphere without lateral offset. Recently, lower inclination angles of the humeral component as well as lateralized glenospheres are implanted to provide better rotation of the arm and to decrease the rate of scapular notching. This study investigates the clinical and radiological results of a standard reverse total shoulder in comparison with an implant with an inclination angle of 135° in combination with a 4 mm lateralized glenosphere in context of cuff tear arthropathy.
Material and methods
For this retrospective comparative analysis 42 patients treated by reverse total shoulder arthroplasty for cuff tear arthropathy were included. Twenty-one patients (
m
= 11,
f
= 10; mean age 76 years; mean follow-up 42 months) were treated with a standard 155° humeral component and a standard glenosphere with caudal eccentricity (group
A
), while twenty-one patients (
m
= 5,
f
= 16; mean age 72 years; mean follow-up 34 months) were treated with a 135° humeral component and 4 mm lateral offset of the glenosphere (group
B
). At follow-up patients of both groups were assessed with plain X-rays (a.p. and axial view), Constant Score, adjusted Constant Score, the subjective shoulder value and the range of motion.
Results
The clinical results were similar in both groups concerning the Constant Score (group
A
= 56.3 vs. group
B
= 56.1;
p
= 0.733), the adjusted CS (group
A
= 70.4% vs. group
B
= 68.3%;
p
= 0.589) and the SSV (group
A
= 72.0% vs. group
B
= 75.2%;
p
= 0.947). The range of motion of the operated shoulders did not differ significantly between group
A
and group
B
: Abduction = 98° versus 97.9°,
p
= 0.655; external rotation with the arm at side = 17.9° versus 18.7°,
p
= 0.703; external rotation with the arm positioned in 90° of abduction = 22.3° versus 24.7°,
p
= 0.524; forward flexion = 116.1° versus 116.7°,
p
= 0.760. The rate of scapular notching was higher (
p
= 0.013) in group
A
(overall: 66%, grade 1: 29%, grade 2: 29%, grade 3: 10%, grade 4: 0%) in comparison to group
B
(overall: 33%, grade 1: 33%, grade 2: 0%, grade 3: 0%, grade 4: 0%). Radiolucency around the humeral component was detected in two patients of group B. Stress shielding at the proximal humerus was observed in six patients of Group
A
(29%; cortical thinning and osteopenia in zone M1 and L1) and two patients of group
B
(10%; cortical thinning and osteopenia in zone M1 and L1). Calcifications of the triceps origin were observed in both groups (group
A
= 48% vs. group
B
= 38%).
Conclusion
Theoretically, a lower inclination angle of the humeral component and an increased lateral offset of the glenosphere lead to improved impingement-free range of motion and a decreased rate of scapular notching, when compared to a standard reverse total shoulder implant. This study compared two different designs of numerous options concerning the humeral component and the glenosphere. In comparison to a standard-fashioned implant with a humeral inclination of 155° and a standard glenosphere, implants with a humeral inclination angle of 135° and a 4 mm lateralized glenosphere lead to comparable clinical results and rotatory function, while the rate of scapular notching is decreased by almost 50%. While the different implant designs did not affect the clinical outcome, our results indicate that a combination of a lower inclination angle of the humeral component and lateralized glenosphere should be favored to reduce scapular notching.
Level of evidence
Level III, retrospective comparative study</description><subject>Aged</subject><subject>Arthroplasty, Replacement, Shoulder</subject><subject>Humans</subject><subject>Humerus - surgery</subject><subject>Joint replacement surgery</subject><subject>Joint surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Prosthesis Design</subject><subject>Range of motion</subject><subject>Range of Motion, Articular</subject><subject>Retrospective Studies</subject><subject>Rotator Cuff Tear Arthropathy - surgery</subject><subject>Shoulder</subject><subject>Shoulder Joint - diagnostic imaging</subject><subject>Shoulder Joint - surgery</subject><subject>Shoulder Prosthesis</subject><subject>Surgical Orthopedics</subject><subject>Transplants & implants</subject><subject>Traumatic Surgery</subject><issn>1633-8065</issn><issn>1432-1068</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU2L1TAYhYsozjj6B1xIwI2baj76kbgRGfyCATfjOqTJm9sOaVKTVLg_039k2jt3BBcuQsJ7nnPewKmqlwS_JRj37xLGrcA1pqQc0Xd186i6JA2jNcEdf1zeHWM1x117UT1L6Q5j0grSPq0uGOPbuLmsft9GUHnyB6RXa1EGFZGKeYxhUXk8ouGIIvyCmADlkJVDaQyrM_BAOZXy8T0yAeUR0OS1m3wJDB4Fu4_GdYZYjDrMS_DgM1Le7IpTeVeCtQnymT848CEtI8QtzroVvIZd2aInXQzngKjMFFw47MOw5rICPjyvnljlEry4v6-qH58_3V5_rW--f_l2_fGm1qxvcy2ADaJjAxeaALeCtYIbwoF2PXBquABsBz70nIDhpKeUm0aboWeNwlRjza6qN6fcJYafK6Qs5ylpcE55CGuStCUdpaxpuoK-_ge9C2v05XeSdpQI2lCyUfRE6RhSimDlEqdZxaMkWG6Fy1PhshQu98JlU0yv7qPXYQbzYDk3XAB2AlKR_AHi393_if0DUBy7Lw</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Holschen, Malte</creator><creator>Kiriazis, Alexandros</creator><creator>Bockmann, Benjamin</creator><creator>Schulte, Tobias L.</creator><creator>Witt, Kai-Axel</creator><creator>Steinbeck, Jörn</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7293-2224</orcidid></search><sort><creationdate>20220201</creationdate><title>Treating cuff tear arthropathy by reverse total shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical and the radiological outcome?</title><author>Holschen, Malte ; Kiriazis, Alexandros ; Bockmann, Benjamin ; Schulte, Tobias L. ; Witt, Kai-Axel ; Steinbeck, Jörn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-9e3b963b89c1e8f93598d18e267e82d89e0fb8b781ed817228d4cdb734a02c0c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Arthroplasty, Replacement, Shoulder</topic><topic>Humans</topic><topic>Humerus - surgery</topic><topic>Joint replacement surgery</topic><topic>Joint surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Prosthesis Design</topic><topic>Range of motion</topic><topic>Range of Motion, Articular</topic><topic>Retrospective Studies</topic><topic>Rotator Cuff Tear Arthropathy - surgery</topic><topic>Shoulder</topic><topic>Shoulder Joint - diagnostic imaging</topic><topic>Shoulder Joint - surgery</topic><topic>Shoulder Prosthesis</topic><topic>Surgical Orthopedics</topic><topic>Transplants & implants</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Holschen, Malte</creatorcontrib><creatorcontrib>Kiriazis, Alexandros</creatorcontrib><creatorcontrib>Bockmann, Benjamin</creatorcontrib><creatorcontrib>Schulte, Tobias L.</creatorcontrib><creatorcontrib>Witt, Kai-Axel</creatorcontrib><creatorcontrib>Steinbeck, Jörn</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery & traumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Holschen, Malte</au><au>Kiriazis, Alexandros</au><au>Bockmann, Benjamin</au><au>Schulte, Tobias L.</au><au>Witt, Kai-Axel</au><au>Steinbeck, Jörn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treating cuff tear arthropathy by reverse total shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical and the radiological outcome?</atitle><jtitle>European journal of orthopaedic surgery & traumatology</jtitle><stitle>Eur J Orthop Surg Traumatol</stitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>32</volume><issue>2</issue><spage>307</spage><epage>315</epage><pages>307-315</pages><issn>1633-8065</issn><eissn>1432-1068</eissn><abstract>Purpose
Reverse total shoulder arthroplasty is widely used for the treatment of cuff tear arthropathy. Standard implants consist of a humeral component with an inclination angle of 155° and a glenosphere without lateral offset. Recently, lower inclination angles of the humeral component as well as lateralized glenospheres are implanted to provide better rotation of the arm and to decrease the rate of scapular notching. This study investigates the clinical and radiological results of a standard reverse total shoulder in comparison with an implant with an inclination angle of 135° in combination with a 4 mm lateralized glenosphere in context of cuff tear arthropathy.
Material and methods
For this retrospective comparative analysis 42 patients treated by reverse total shoulder arthroplasty for cuff tear arthropathy were included. Twenty-one patients (
m
= 11,
f
= 10; mean age 76 years; mean follow-up 42 months) were treated with a standard 155° humeral component and a standard glenosphere with caudal eccentricity (group
A
), while twenty-one patients (
m
= 5,
f
= 16; mean age 72 years; mean follow-up 34 months) were treated with a 135° humeral component and 4 mm lateral offset of the glenosphere (group
B
). At follow-up patients of both groups were assessed with plain X-rays (a.p. and axial view), Constant Score, adjusted Constant Score, the subjective shoulder value and the range of motion.
Results
The clinical results were similar in both groups concerning the Constant Score (group
A
= 56.3 vs. group
B
= 56.1;
p
= 0.733), the adjusted CS (group
A
= 70.4% vs. group
B
= 68.3%;
p
= 0.589) and the SSV (group
A
= 72.0% vs. group
B
= 75.2%;
p
= 0.947). The range of motion of the operated shoulders did not differ significantly between group
A
and group
B
: Abduction = 98° versus 97.9°,
p
= 0.655; external rotation with the arm at side = 17.9° versus 18.7°,
p
= 0.703; external rotation with the arm positioned in 90° of abduction = 22.3° versus 24.7°,
p
= 0.524; forward flexion = 116.1° versus 116.7°,
p
= 0.760. The rate of scapular notching was higher (
p
= 0.013) in group
A
(overall: 66%, grade 1: 29%, grade 2: 29%, grade 3: 10%, grade 4: 0%) in comparison to group
B
(overall: 33%, grade 1: 33%, grade 2: 0%, grade 3: 0%, grade 4: 0%). Radiolucency around the humeral component was detected in two patients of group B. Stress shielding at the proximal humerus was observed in six patients of Group
A
(29%; cortical thinning and osteopenia in zone M1 and L1) and two patients of group
B
(10%; cortical thinning and osteopenia in zone M1 and L1). Calcifications of the triceps origin were observed in both groups (group
A
= 48% vs. group
B
= 38%).
Conclusion
Theoretically, a lower inclination angle of the humeral component and an increased lateral offset of the glenosphere lead to improved impingement-free range of motion and a decreased rate of scapular notching, when compared to a standard reverse total shoulder implant. This study compared two different designs of numerous options concerning the humeral component and the glenosphere. In comparison to a standard-fashioned implant with a humeral inclination of 155° and a standard glenosphere, implants with a humeral inclination angle of 135° and a 4 mm lateralized glenosphere lead to comparable clinical results and rotatory function, while the rate of scapular notching is decreased by almost 50%. While the different implant designs did not affect the clinical outcome, our results indicate that a combination of a lower inclination angle of the humeral component and lateralized glenosphere should be favored to reduce scapular notching.
Level of evidence
Level III, retrospective comparative study</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>33880654</pmid><doi>10.1007/s00590-021-02976-4</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7293-2224</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1633-8065 |
| ispartof | European journal of orthopaedic surgery & traumatology, 2022-02, Vol.32 (2), p.307-315 |
| issn | 1633-8065 1432-1068 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2516223446 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Aged Arthroplasty, Replacement, Shoulder Humans Humerus - surgery Joint replacement surgery Joint surgery Medicine Medicine & Public Health Original Article Prosthesis Design Range of motion Range of Motion, Articular Retrospective Studies Rotator Cuff Tear Arthropathy - surgery Shoulder Shoulder Joint - diagnostic imaging Shoulder Joint - surgery Shoulder Prosthesis Surgical Orthopedics Transplants & implants Traumatic Surgery |
| title | Treating cuff tear arthropathy by reverse total shoulder arthroplasty: do the inclination of the humeral component and the lateral offset of the glenosphere influence the clinical and the radiological outcome? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T08%3A50%3A26IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Treating%20cuff%20tear%20arthropathy%20by%20reverse%20total%20shoulder%20arthroplasty:%20do%20the%20inclination%20of%20the%20humeral%20component%20and%20the%20lateral%20offset%20of%20the%20glenosphere%20influence%20the%20clinical%20and%20the%20radiological%20outcome?&rft.jtitle=European%20journal%20of%20orthopaedic%20surgery%20&%20traumatology&rft.au=Holschen,%20Malte&rft.date=2022-02-01&rft.volume=32&rft.issue=2&rft.spage=307&rft.epage=315&rft.pages=307-315&rft.issn=1633-8065&rft.eissn=1432-1068&rft_id=info:doi/10.1007/s00590-021-02976-4&rft_dat=%3Cproquest_cross%3E2516223446%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2621924216&rft_id=info:pmid/33880654&rfr_iscdi=true |