Acromial insufficiency in reverse shoulder arthroplasties

Walch, Gilles; Mottier, F.; Wall, Bryan; Boileau, Pascal; Molé, Daniel; Favard, Luc

doi:10.1016/j.jse.2008.12.002

Cited by 167 publications

(157 citation statements)

References 16 publications

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“…The effect of lateralizing the glenosphere by 10 mm also may be concerning as this level of offset has been popularized (eg, the bony increased-offset reversed shoulder arthroplasty technique of Boileau et al [6]) and is endorsed in some product technical manuals [10,29] as a means to reduce scapular notching. Conversely, humeral lateralization is the only parameter in this model that decreased deltoid force and thus should be an important consideration when designing implants to address the clinical problems of deltoid fatigue and acromial fracture, which are both associated with increased deltoid force [8,15,30]. Humeral polyethylene cup thickness was found to have a small effect on deltoid load that approached our Fig.…”

Section: Discussionmentioning

confidence: 58%

“…The deltoid muscle force required to produce active motion and the resulting joint load magnitude and angle throughout this motion are important factors when considering the potential effect of implant configuration on long-term RTSA performance. Specifically, after RTSA, arm elevation primarily is dependent on the deltoid, but large increases in this muscle's force may be associated with acromial fracture and chronic muscle fatigue [8,15,30,32]. In addition, increased joint loading has been linked with greater implant wear and fixation failure [4].…”

Section: Introductionmentioning

confidence: 99%

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Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Giles

Langohr

Johnson

et al. 2015

Clinical Orthopaedics &Amp; Related Research

143

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Background Reverse total shoulder arthroplasty (RTSA) is widely used; however, the effects of RTSA geometric parameters on joint and muscle loading, which strongly influence implant survivorship and long-term function, are not well understood. By investigating these parameters, it should be possible to objectively optimize RTSA design and implantation technique. Questions/purposes The purposes of this study were to evaluate the effect of RTSA implant design parameters on (1) the deltoid muscle forces required to produce abduction, and (2) the magnitude of joint load and (3) the loading angle throughout this motion. We also sought to determine how these parameters interacted.Methods Seven cadaveric shoulders were tested using a muscle load-driven in vitro simulator to achieve repeatable motions. The effects of three implant parameters-humeral lateralization (0, 5, 10 mm), polyethylene thickness (3, 6, 9 mm), and glenosphere lateralization (0, 5, 10 mm)-were assessed for the three outcomes: deltoid muscle force required to produce abduction, magnitude of joint load, and joint loading angle throughout abduction. Results Increasing humeral lateralization decreased deltoid forces required for active abduction (0 mm: 68% ± 8% [95% CI, 60%-76% body weight (BW)]; 10 mm: 65% ± 8% [95% CI, 58%-72 % BW]; p = 0.022). Increasing glenosphere lateralization increased deltoid force (0 mm: 61% ± 8% [95% CI, 55%-68% BW]; 10 mm: 70% ± 11% [95% CI, 60%-81% BW]; p = 0.007) and joint loads (0 mm: 53% ± 8% [95% CI, 46%-61% BW]; 10 mm: 70% ± 10% [95% CI, 61%-79% BW]; p \ 0.001). Increasing polyethylene cup thickness increased deltoid force (3 mm: 65% ± 8% [95% CI, 56%-73% BW]; 9 mm: 68% ± 8% [95% CI, 61%-75% BW]; p = 0.03) and joint load (3 mm: 60% ± 8% [95% CI, 53%-67% BW]; 9 mm: 64% ± 10% [95% CI, 56%-72% BW

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Giles

Langohr

Johnson

et al. 2015

Clinical Orthopaedics &Amp; Related Research

143

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“…Lengthening of the arm and subsequent increased tension in the deltoid may be responsible for a fatigue fracture of the acromion; nine percent of the cases showed different previous acromial congenital or acquired modifications that had no or little influence on the result. Perioperative fracture of the scapular spine was seen in one case and resulted in a poor outcome [47]. In our personal experience we observed two cases of acromial fractures following RTSA; both fractures occurred between three and eight weeks after surgery and had no major effect on the outcome (Fig.…”

Section: De Wilde and Walch Published A Report Of Three Casesmentioning

confidence: 85%

“…Partial disengagement was noted in 45.4 % of the Aequalis prostheses and in 1. [47]. A total of 283 prostheses were implanted in patients with no history of shoulder surgery, while 174 cases were performed for revision of a previously failed procedure.…”

Section: De Wilde and Walch Published A Report Of Three Casesmentioning

confidence: 99%

Complications with reverse total shoulder arthroplasty and recent evolutions

Scarlat¹

2013

International Orthopaedics (SICOT)

121

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Since its description by Paul Grammont from Dijon, France, several tens of thousands of reverse total shoulder arthroplasties (RTSA) have been performed for diverse conditions. The purpose of this analysis is to identify the complications of this procedure in the literature and in clinical practice. A total of 240 papers concerning RTSA published between 1996 and 2012 have been identified. Over 80 papers describe complications associated with this type of implant. A list of prostheses satisfying European and US standards, CE and FDA approved, has been produced on the basis of information provided by the manufacturers. Data from the literature do not support a meta-analysis. The inventory of best practices shows excellent results in the short and medium term in specific indications, while the number of complications varies between 10 and 65 % in long-term series. Complications can be classified into (A) non-specific including infections (superficial and deep), phlebitis, haematoma, neurological complications of the suprascapular, radial and axillary nerves and (B) specific complications associated with RTSA including (1) on the glenoid side: intraoperative fracture of the glenoid and acromion, late fracture of the scapula, impingement at the scapular neck (notching), glenoid loosening, dissociation of the glenoid component (snatching of the glenosphere) and fractures of the glenoid baseplate; (2) on the humeral side: metaphyseal deterioration, humeral loosening, instability of the shoulder, stiffness with limitation of external and/or internal rotation; and (3) muscular complications with fatty degeneration of the deltoid. Additionally we have identified specific situations related to the type of implant such as the disassembly of the humeral or the glenoid component, dissociation of the polyethylene humeral plate, dissociation of the metaphysis and osteolysis of the tuberosities. The integration of results from different clinical series is difficult because of the lack of a database and the multitude of implants used.

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“…51) Postoperative acromion fractures are also one of common complications. 21,54) The reason of this complications is still unclear, but it frequently occurs at the base of acromion and also occurs at the shaft of clavicle (Fig. 2).…”

Section: Complicationsmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear

Jeong¹,

Eun²

2014

Clin Shoulder Elbow

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In the patients of retracted massive rotator cuff tears, there are much of difficulty to functional recovery and pain relief. Nevertheless the development of treatment, there are still debates of the best treatments in the massive rotator cuff tears. Recenlty various of treatments are introduced; these are acromioplasty with debridement, biceps tenotomy, great tuberoplasty with biceps tenotomy, partial repair, mini-open rotator cuff repair, arthroscopic rotator cuff repair, soft tissue augmentation, tendon transfer, flap, hemiarthroplasty, and reverse total shoulder arthroplasty. That there is no difference of result for reverse total shoulder arthroplasty between patients who have massive rotator cuff tear without arthritis and patients who have cuff tear arthropathy. Reverse total shoulder arthroplasty is one of reliable and successful treatment options for massive rotator cuff tear. Especially it is more effective for patients who have a pseudoparalysis. (Clin Shoulder Elb 2014;17(3):145-150)

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Acromial insufficiency in reverse shoulder arthroplasties

Cited by 167 publications

References 16 publications

Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Complications with reverse total shoulder arthroplasty and recent evolutions

Reverse Total Shoulder Arthroplasty in the Massive Rotator Cuff Tear

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