Neurologic deficit after reverse total shoulder arthroplasty: correlation with distalization

Kim, Kang‐Il; Kwon, Tae Yoon; Jeon, Young-Chan; Kang, Se Gu; Rhee, Yong Girl; Rhee, Sung Min

doi:10.1016/j.jse.2019.11.014

Cited by 51 publications

(41 citation statements)

References 27 publications

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“…In our series, glenoid inclination as measured by the b angle improved by 14 , whereas Boileau et al 4 reported a 27 improvement in glenoid inclination as measured by the RSA angle. The correction of glenoid retroversion in patients with Walch type B2, B3, and C glenoids obtained in our series (12 ) was similar to what was reported by Boileau et al 4 (10.5 ). Structural bone graft has been associated with high rates of graft incorporation and excellent outcomes in some series 3,4,16 ; however, other recent literature has reported graft resorption in 20%-25% of cases with high rates of baseplate failure and reoperation.…”

Section: Discussionsupporting

confidence: 92%

“…Computed tomography or magnetic resonance imaging was used to classify the primary glenoid deformity according to the Walch 2,29 or Favard 15 classification system, glenoid version, humeral head subluxation relative to the plane of the scapula, 20 and posterior bone loss for patients with Walch type B2 glenoids. Immediate preoperative radiographs of interest consisted of the true anteroposterior (Grashey) and axillary views, which were used to determine the global glenoid inclination as measured by the b angle, 4,18 the acromiohumeral distance (AHD), 12 and the lateral humeral offset (LHO). 12 The same series of radiographs was reviewed within 3 months of surgery to assess for very early radiographic failure and determine overall deformity correction as measured by the b angle, AHD, LHO, and glenoid version.…”

Section: Radiographic Data Collectionmentioning

confidence: 99%

“…Immediate preoperative radiographs of interest consisted of the true anteroposterior (Grashey) and axillary views, which were used to determine the global glenoid inclination as measured by the b angle, 4,18 the acromiohumeral distance (AHD), 12 and the lateral humeral offset (LHO). 12 The same series of radiographs was reviewed within 3 months of surgery to assess for very early radiographic failure and determine overall deformity correction as measured by the b angle, AHD, LHO, and glenoid version. 8,9 The radiographic difference between these variables compared with preoperative measurements was used to calculate deformity correction.…”

Section: Radiographic Data Collectionmentioning

confidence: 99%

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Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Kirsch

Patel

Singh

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Glenoid deformity is commonly encountered in patients undergoing reverse shoulder arthroplasty (RSA). Augmented baseplates can correct glenoid deformity while potentially avoiding certain complications encountered with structural bone graft. Limited evidence exists to support the use of metallic augmented baseplates in RSA. Methods: We performed a retrospective review to identify all patients treated with an augmented baseplate during primary RSA with a minimum of 1 year of clinical and radiographic follow-up. Preoperative radiographs and advanced imaging were used to determine glenoid morphology and deformity. Postoperative radiographs were used to evaluate for deformity correction, radiographic complications, and early baseplate loosening or failure. Prospectively collected clinical data and patient-reported outcome scores were determined. Results: Primary RSA was performed with an augmented baseplate in 44 patients (mean age, 72 AE 6 years; 15 half-wedge and 29 fullwedge augmentations). Glenoid retroversion was significantly improved for the entire cohort (P ¼ .001). Among the 22 patients with either Walch type B2, B3, or C glenoid morphology, glenoid version improved from 28 AE 8 to 16 AE 8 (P ¼ .001). Glenoid inclination, as determined by the b angle, was significantly improved for the entire cohort (P < .001). Among the 18 patients with Favard type E2 or E3 glenoid morphology, glenoid inclination improved from 67 AE 7 to 81 AE 8 (P < .001). Postoperative range of motion and functional outcome scores including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Single Assessment Numeric Evaluation score, and visual analog scale score for pain significantly improved within the entire cohort (P < .05). No patients had evidence of baseplate loosening or failure of the glenoid component. Acromial stress fractures developed in 5 patients (11.4%), and 2 patients (4.5%) underwent a reoperation unrelated to the glenoid component. Discussion and conclusion: Primary RSA with an augmented baseplate results in excellent short-term clinical outcomes and significant deformity correction in patients with advanced glenoid deformity. There were no complications related to the augmented baseplate or glenoid component. The rate of acromial stress fractures appears higher than typically reported and warrants further investigation.This study was approved by the Thomas Jefferson University Institutional Review Board (no. 19D.732).

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Section: Discussionsupporting

confidence: 92%

Section: Radiographic Data Collectionmentioning

confidence: 99%

Section: Radiographic Data Collectionmentioning

confidence: 99%

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Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Kirsch

Patel

Singh

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…These complications include acromial and scapular spine fractures, inferior glenoid notching, and subcoracoid impingement. 11,20 Some authors have also found a higher rate of deep infection in patients undergoing RSA when compared with TSA. 16,21 In addition, restoration of motion seems to be superior with anatomic TSA, especially in terms of internal rotation.…”

mentioning

confidence: 99%

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Jensen

Tangtiphaiboontana

Marigi

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The relative indications of anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) continue to evolve. Some surgeons favor RSA over TSA for elderly patients with primary glenohumeral osteoarthritis (GHOA) and an intact rotator cuff due to fear of a postoperative (secondary) rotator cuff tear in this age group. However, RSA is associated with unique complications and a worse functional arc of motion compared with TSA. Therefore, it is important to understand the clinical outcomes and rates of revision surgery and secondary rotator cuff tears in elderly patients undergoing TSA. Methods: Between January 1, 2010, and December 31, 2017, 377 consecutive TSAs were performed for primary GHOA in 340 patients 70 years of age or older. The mean age at surgery was 76.2 years (standard deviation [SD], 4.9). Clinical evaluation included pain, motion, and American Shoulder and Elbow Surgeons score. Radiographs were reviewed for preoperative morphology and postoperative complications. All complications and reoperations were recorded. The average clinical follow-up time was 3.3 years (SD, 2.0). Statistical analyses were performed, and Kaplan-Meier implant survival estimates were calculated. For all analyses, a P value <.05 was considered statistically significant. Results: The mean pain visual analog scale and American Shoulder and Elbow Surgeons score at the final follow-up were 1.6 (SD, 2.2) and 78.0 (SD, 17.8), respectively. Forward elevation and external rotation increased from 96 (SD, 30 ) and 26 (SD, 20 ) preoperatively to 160 (SD, 32 ) and 64 (SD, 26 ) postoperatively (P < .001 for each). The percentage of patients who had internal rotation to L5 or greater increased from 24.8% preoperatively to 71.8% postoperatively (P < .001). Revision surgery was performed in 3 shoulders (0.8%), and the 5-year implant survival estimate was 98.9% (95% confidence interval: 97.3%-100%). There were 3 medical (0.8%), 10 minor surgical (2.7%), and 5 major surgical (1.3%) complications. No shoulder had radiographic evidence of humeral component loosening, whereas 7 (2%) had evidence of some degree of glenoid component loosening. In total, there were 5 secondary rotator cuff tears (1.3%), of which 2 (0.5%) required revision surgery. Conclusion: Elderly patients with primary GHOA and an intact rotator cuff have excellent clinical and radiographic outcomes after This study was reviewed and approved by our institutional review board (#12-007498).

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“…The non-anatomic design of RTSA can lead to brachial plexus or axillary nerve injury (neuropraxia) mostly due to lengthening of the involved arm and elongation of the brachial plexus. 62 Van Hoof et al 63 reported a strain of up to 15.3% and 19.3% for the lateral and the medial root of the median nerve related to reverse shoulder prosthesis. Intraoperative factors such as arm manipulation, excessive traction or lengthening of the arm have been noted to contribute to nerve injury following RTSA.…”

Section: Neurological Deficitsmentioning

confidence: 99%

Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty

Razmjou

Osnabrugge

Anunciacion

et al. 2021

Journal of Shoulder and Elbow Arthroplasty

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Purpose The purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence. Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications. Results In light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position. Conclusion Improving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.

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Neurologic deficit after reverse total shoulder arthroplasty: correlation with distalization

Cited by 51 publications

References 27 publications

Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis is associated with excellent outcomes and low revision rates in the elderly

Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty

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