Influence of glenosphere design and material on clinical outcomes of reverse total shoulder arthroplasty

Bloch, Hans Rudolf; Budassi, Piero; Bischof, A; Agneskirchner, Jens D.; Domenghini, Christian; Frattini, Marco; Borroni, Mario; Zoni, Sabine; Castagna, Alessandro

doi:10.1177/1758573214535574

Cited by 20 publications

(19 citation statements)

References 35 publications

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The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Shah

Roche²,

Sullivan³

et al. 2021

JSES International

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Background Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous. Methods Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests. Results The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; P < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; P = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%. Conclusions Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.

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The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Shah

Roche²,

Sullivan³

et al. 2021

JSES International

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“…The inversion of conventional bearing materials was recently introduced in reverse total shoulder arthroplasty (rTSA) using an all-polyethylene glenosphere articulating against a metal humeral inlay. [9][10][11] The idea of bearing material inversion was supported by the need to avoid the scapular notching phenomenon. This complication is due to mechanical impingement and abrasion of the polyethylene humeral inlay against the scapular bone, which leads to increased polyethylene debris generation and osteolysis.…”

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Wear performance of inverted non-conforming bearings in anatomic total shoulder arthroplasty

Banci¹,

Meoli²,

Hintner³

et al. 2019

Shoulder & Elbow

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Background: Glenoid component failures still represent the most common complication in total shoulder arthroplasty. These failures depend on several factors, including ultra-high molecular weight polyethylene (UHMWPE) wear. One reason for UHMWPE wear in total shoulder arthroplasty may be the current use of a spherical prosthetic humeral head against a radially mismatched UHMWPE glenoid component, which leads to reduced glenohumeral translations, glenoid edge loading and high translational forces during shoulder motions. The aim of this study was to assess the in vitro wear of an anatomic total shoulder prosthesis with non-spherical non-conforming bearings with inverted conventional materials. Methods: The wear of a vitamin E-blended UHMWPE non-spherical humeral head articulating against a non-conforming titanium-niobium nitride (TiNbN)-coated metallic glenoid was tested using a joint simulator. The wear test was performed by applying a constant load of 756 N with angular motions and translations. Results: After 2.5 million cycles, the mean wear rate of the humeral head was 0.28 AE standard deviation (SD) 0.45 mg/million cycles. Conclusion: The low wear rate of the vitamin E UHMWPE humeral head supports the use of non-spherical nonconforming bearings with inverted conventional materials in anatomic total shoulder arthroplasty. Keywords ultra-high molecular weight polyethylene wear, total shoulder arthroplasty, non-spherical humeral head, inverted bearing materials, non-conforming bearings Date

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“… 18 Various factors have been reported that are related to the poor improvement of shoulder function after RSA including age, 15 , 18 sex, 15 patients’ stature, 27 obesity, 39 deltoid muscle volume, 43 preoperative range of motion, 14 preoperative diagnosis, 11 , 19 , 42 and glenosphere size and position. 6 , 10 , 30 , 32 , 33 …”

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Three-dimensional kinematics of reverse shoulder arthroplasty: a comparison between shoulders with good or poor elevation

et al. 2021

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Background Various factors may be related to outcomes of reverse shoulder arthroplasty (RSA) including patient and surgical factors. Differences in shoulder kinematics might be associated with poor function after RSA; however, kinematic differences between shoulders with good or poor elevation have not been elucidated. The purpose of this study was to compare RSA kinematics between shoulders with good or poor elevation. Methods The study included 28 shoulders with a minimum 6-month follow-up after RSA using Grammont-type prostheses. Subjects comprised 17 men and 11 women with the mean age of 75 years (range, 63-91). Subjects underwent fluoroscopy during active scapular plane abduction. Computed tomography of their shoulders was performed to create 3-dimensional scapular implant models. Using model-image registration techniques, poses of 3-dimensional implant models were iteratively adjusted to match their silhouettes with the silhouettes in the fluoroscopic images, and 3-dimensional kinematics of implants were computed. Kinematics and glenosphere orientation were compared between shoulders with good (>90 degree) or poor (<90 degree) scapular plane abduction. Results Nineteen and 9 shoulders were assigned to the good- and poor-elevation groups, respectively. There were no significant differences between the groups in age, sex, height, weight, preoperative range of motion, or Constant score, but body mass index in the poor elevation shoulders was significantly larger than that in the good elevation shoulders. There were no significant differences in glenosphere (upward/downward rotation, anterior/posterior tilt, internal/external rotation) or glenohumeral (internal/external rotation, abduction/adduction) kinematics between the good and poor elevation shoulders. Scapulohumeral rhythm was significantly higher in the good elevation shoulders than the poor elevation shoulders ( P = .04). Glenosphere superior tilt was 2.3° ± 4.2° in the good-elevation group and 8.1° ± 8.9° in the poor-elevation group, and the difference was statistically significant ( P = .03). Discussion Shoulders with good elevation after RSA demonstrated better scapulohumeral rhythm than those with poor elevation, though there were no significant differences in glenosphere and glenohumeral kinematics. It may be important for better elevation to achieve good glenohumeral motion in shoulders with RSA. Glenosphere orientations may affect postoperative shoulder function.

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Influence of glenosphere design and material on clinical outcomes of reverse total shoulder arthroplasty

Cited by 20 publications

References 35 publications

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

The modern reverse shoulder arthroplasty and an updated systematic review for each complication: part II

Wear performance of inverted non-conforming bearings in anatomic total shoulder arthroplasty

Three-dimensional kinematics of reverse shoulder arthroplasty: a comparison between shoulders with good or poor elevation

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