Inferior tilt of the glenoid component does not decrease scapular notching in reverse shoulder arthroplasty: results of a prospective randomized study

Edwards, T. Bradley; Trappey, George J.; Riley, Clayton; O’Connor, Daniel P.; Elkousy, Hussein; Gartsman, Gary M.

doi:10.1016/j.jse.2011.08.057

Cited by 125 publications

(84 citation statements)

References 18 publications

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“…Active flexion was 130°, active external rotation 90°, shoulder abduction 60°and internal rotation to the level of T12 scapular notching [50]. Edwards et al [13], in a randomised study, found that inferior glenoid tilt did not decrease scapular notching. Moreover, it has also been suggested that too much inferior tilt can increase scapular notching [31,39] because of the induced humeral bearing medialisation.…”

Section: Discussionmentioning

confidence: 97%

“…This implant has a more medialised design, with a COR at the bone-implant interface. Rates of scapular notching varied between 40 % and 74 % [2,12,13,15,36,40,43,44], with a maximum of 96 % [48]. In most publications, the rate of scapular notching continued to increase over time.…”

Section: Discussionmentioning

confidence: 99%

“…This approach induces medialisation of the centre of rotation (COR) and a lowering of the humerus, leading to an increase of the deltoid-moment arm, which restored good elevation in pseudoparalytic shoulders. This Grammont design yields satisfactory functional results, but numerous publications demonstrated that this improvement in elevation comes at a price [2,13,27,29,30,33,38,40,43,44,48]: loss of medial and lateral rotation [23,25], loss of shoulder contour, risk of instability and a high percentage of scapular notching. The latter complication is reported in around 75 % of cases [2,15,43] and up to 96 % in some series [48], and it can be observed as early as three to six months postoperatively [34,40,43].…”

Section: Introductionmentioning

confidence: 99%

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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

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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Purpose Our purpose was to evaluate the influence of metallic lateralisation of the centre of rotation (COR) in reverse shoulder arthroplasty (RSA) on the incidence of scapular notching and its eventual clinical and radiological consequences. Methods We analysed 140 RSAs with a lateralised design (Arrow, FH Orthopedics, Mulhouse, France) implanted for massive rotator cuff tear with/without arthritis. Mean followup was 45 months (range 24-120, standard deviation 20). Patients were evaluated clinically using the Constant and Murley (Clin Orthop Relat Res 214:160-164, 1987) score and active range of motion (ROM) and radiologically using standard anteroposterior and axillary view. Scapular notching was assessed according to Sirveaux classification Simovitch et al. (J Bone Joint Surg Am, 89:588-600, 2007), and patients were separated into two groups (scapular notch/no scapular notch) and compared. Results Forty-one notches (29 %) were found: 20 grade 1, 18 grade 2, and three grade 3. The latter three patients had a follow-up of 44, 70 and 84 months, respectively, and the scapular notch did not evolve in the final two years. Better preoperative function was significantly associated with scapular notching (p<0,05 for flexion and abduction), but no final clinical differences in ROM and Constant score were found between groups. A body mass index (BMI) <30 increased the risk of scapular notching, which was observed in 43 % of patients with a BMI<30 and 30 % of patients with a BMI> 30 p=0,048). Pre-operative narrowing of the subacromial space increased the risk of scapular notching, but age or gender showed no influence. However, there was a significantly greater number of scapular notches in patients operated on the dominant side (p=0,04). No significant difference in lateral offset was found between groups (p=0,99). Glenoid implantation in an excessively high position (p=0,033) and absence of inferior tilt (p=0,0029) were significantly associated with scapular notching. Conclusions In this series, metallic lateralisation of the COR in RSA did not impair clinical results, with patients achieving good flexion recovery ROM increase in rotations. Metallic lateralisation of the COR in RSA leads to a lower incidence of scapular notching (29 %) compared with previously reported results using other arthroplastic systems with a more medialised COR. However, although scapular notching was not totally eliminated, those that were found did not evolve over time. Several factors increased the incidence of scapular notching: BMI <30, better preoperative ROM, an excessively high glenoid implant and absence of inferior tilt.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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“…There are divergent findings about the effect of inferior inclination on the incidence of SN. Some denied its effect [19,20], while others reported decreased [17,21] or increased incidence of SN [8].…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study

Kadum

Mukka

Englund

et al. 2014

International Orthopaedics (SICOT)

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Purpose The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. Methods This was a prospective comparative nonrandomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. Results We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome.Conclusions Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.

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“…Although major problems of initial reverse designs and positioning have been solved, 2,16 impingement causing a limitation of mobility is still an open question. 2,6,8,15,16 It has been analyzed with different prosthesis design by several biomechanical models [8][9][10]16 ; but it was never evaluated in activities of daily living, and never related to scapular compensation. In the present study, the occurrence of impingement in typical activities of daily living was rather low, and only observed for adducted positions.…”

Section: Discussionmentioning

confidence: 99%

Activities of daily living with reverse prostheses: importance of scapular compensation for functional mobility of the shoulder

Terrier¹,

Scheuber²,

Pioletti³

et al. 2013

Journal of Shoulder and Elbow Surgery

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Hypothesis:The nonanatomical design of reverse shoulder prostheses induce medial displacement of the center of rotation, impingements and may reduce the mobility of the shoulder. The aim of this study is to test the hypothesis that during activities of daily living functional mobility of the shoulder can be restored by scapular compensation. Material and methods: A numerical 3-dimensional model was developed to reproduce the movement of the scapula and humerus, during 4 activities of daily living measured experimentally. This hypothesis was tested in 4 configurations of the aequalis reverse prosthesis (standard 36-mm glenosphere, 42-mm glenosphere, lateralized 36-mm glenosphere, lateralized Bony Increased-Offset Reverse Shoulder Arthroplasty [BIO-RSA]), which were implanted in the virtual model. All impingement positions were evaluated, as the required scapular compensation to avoid impingements. Results: With the 36-mm glenosphere, impingements occurred only for rest of hand to back-pocket positions. The 42-mm partly improved the mobility. The 2 lateralized glenospheres were free of impingement. When impingements occurred, the scapular compensation was less than 10 . Conclusion: Most reverse prostheses impingements reported in clinical and biomechanical studies can be avoided, either by scapular compensation or by a glenosphere lateralization. After reverse shoulder arthroplasty, a fraction of the mobility of the gleno-humeral is transferred to the scapulo-thoracic joint.

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Inferior tilt of the glenoid component does not decrease scapular notching in reverse shoulder arthroplasty: results of a prospective randomized study

Cited by 125 publications

References 18 publications

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

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

Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study

Activities of daily living with reverse prostheses: importance of scapular compensation for functional mobility of the shoulder

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