Outcomes after a Grammont-style reverse total shoulder arthroplasty?

Abstract

Background: The purpose of this study was to determine the factors associated with outcomes after reverse total shoulder arthroplasty (RTSA). Methods: We retrospectively evaluated all RTSAs performed by the senior author between January 1, 2007, and November 1, 2017. We evaluated pain visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores and complication and reoperation rates at a minimum of 2-year follow-up. We evaluated preoperative and 2-week postoperative radiographs for glenoid inclination (GI), medialization as distance between the center of the humeral head or glenosphere and the line of the deltoid, and distalization via the acromial-greater tuberosity distance. We performed inter-and intrarater reliabilities via intraclass correlation coefficients (ICCs) and conducted a multivariable analysis. Results: We included 230 RTSAs in the analysis, with 70% follow-up at a median of 3.4 years. Reliability was acceptable with all ICCs >.678. Increased postoperative GI was significantly associated with increased VAS pain postoperatively (P ¼ .008). Increased distalization was associated with an increased rate of complications and reoperations (P ¼ .032). Younger age (P ¼ .008), female gender (P ¼ .009), and lower body mass index (BMI) (P ¼.006) were associated with worse ASES scores. Female gender (P <.001) and lower BMI (P ¼.039) were associated with worse SST scores. Female gender (P ¼ .013) and lower BMI (P ¼ .005) were associated with worse VAS-pain scores. Conclusion: Age, gender, and BMI are associated with outcome after RTSA. In this retrospective analysis of a Grammont-style RTSA, superior inclination is associated with increased pain postoperatively, whereas excessive arm lengthening is associated with increased risk for complication or reoperation.

Prior Acromioplasty Provides Similar Outcomes and Rate of Postoperative Complications Including Acromial Fracture After Reverse Total Shoulder Arthroplasty: A Retrospective Matched-Cohort Analysis

“…These results are consistent with findings in the previously reported literature on functional outcomes and ROM after RTSA. 9 , 10 Cabarcas et al. 9 performed a systematic review that showed a mean postoperative ASES score of 75.0 in patients undergoing RTSA for rotator cuff tear.…”

Radiographic Analysis of Grammont-Style and Lateralized Reverse Shoulder Arthroplasty in Gleno-Humeral Osteoarthritis

“…Moreover, it increased the lever arm of the deltoid muscle, allowing for elevation strength recovery [1][2][3]. The Grammont prosthesis warranted excellent clinical outcomes and a low revision rate [4,5]. These favorable results led surgeons to expand its indications from exclusively addressing rotator cuff tear arthropathy to encompassing fractures and their sequelae, primary osteoarthritis, avascular necrosis, post-traumatic osteoarthritis, and even cases of irreparable rotator cuff tears [6][7][8].…”

CORR Insights®: Improved Clinical Outcomes After Lateralized Reverse Shoulder Arthroplasty: A Systematic Review

“…The unintended consequences were medial scapular notching and decreased external rotation. Today, proponents of the medial center of rotation generally obtain good results [9], but concerns about scapular notching and decreased ROM have guided others to explore the merits of lateralization [2,5] and even use a more varus neck-shaft angle.…”