Posterior and inferior glenosphere position in reverse total shoulder arthroplasty supports deltoid efficiency for shoulder flexion and elevation

Meisterhans, Michel; Bouaicha, Samy; Meyer, Dominik C.

doi:10.1016/j.jse.2018.12.018

Cited by 16 publications

(11 citation statements)

References 31 publications

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“…These changes in muscle recruitment for abduction are not without cost. As the posterior deltoid is recruited to become an abductor, its external rotation moment arm is lost, contributing to the common external rotation deficit seen following RTSA [16,27]. Other directional moment arms are affected following RTSA as well, and, more recently, subscapularis repair after RTSA has been investigated.…”

Section: Re-tensioning Of the Deltoidmentioning

confidence: 99%

“…The initial description of the basic biomechanics of the RTSA provided insight into how and why this prosthesis works, but since its introduction there has been an expanding body of literature on implications of this shoulder arthroplasty design [3,[6][7][8][9][10]. Updated understandings of the biomechanics and associated complications, such as scapular notching, have allowed for refinements in component positioning and implant design to improve range of motion (ROM), maintain the deltoid lever arm, and minimize joint reactive forces [8,[11][12][13][14][15][16]. The importance of understanding the biomechanics of reverse shoulder anatomy is crucial to produce optimal outcomes after RTSA.…”

Section: Introductionmentioning

confidence: 99%

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Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

Rugg

Coughlan

Lansdown

2019

Curr Rev Musculoskelet Med

110

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Purpose of Review Over the past decade, our understanding of the biomechanics of the reverse total shoulder arthroplasty (RTSA) has advanced, resulting in design adjustments, improved outcomes, and expanding indications. The purpose of this review is to summarize recent literature regarding the biomechanics of RTSA and the evolving indications for its use. Recent Findings While Grammont's principles of RTSA biomechanics remain pillars of contemporary designs, a number of modifications have been proposed and trialed in later generations to address complications such as impingement and glenoid failure. Clinical and biomechanical literature suggest that less medialized, more inferior glenospheres result in less impingement and notching. On the humerus, a more vertical neck cut is associated with less impingement. Indications for RTSA continue to expand beyond the classic indication of cuff tear arthropathy (CTA). Patients without a functional cuff but no arthritis now have a reliable option in the RTSA. RTSA has also replaced hemiarthroplasty as the implant of choice for displaced three-and four-part proximal humerus fractures in the elderly. Finally, updated design options and modular components now allow for treatment of glenoid bone loss, failed arthroplasty, and proximal humerus tumors with RTSA implants. Summary Reverse total shoulder arthroplasty design has been modernized on both the glenoid and humerus to address biomechanical challenges of early implants. As outcomes improve with these modifications, RTSA indications are growing to address complex bony pathologies such as tumor and bone loss. Longitudinal follow-up of patients with updated designs and novel indications is essential to judicious application of RTSA technology.

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Section: Re-tensioning Of the Deltoidmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

Rugg

Coughlan

Lansdown

2019

Curr Rev Musculoskelet Med

110

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“…On the glenoid side, the size and position of glenospheres have been reported as factors associated with postoperative shoulder function. 6 , 10 , 30 , 32 , 33 Several studies have demonstrated that shoulders with a larger glenosphere had better postoperative shoulder function than those with a smaller glenosphere, 6 , 32 , 33 but the same glenosphere size was used in all shoulders in this study. Glenosphere superior inclination was related to the poor outcomes in this study.…”

Section: Discussionmentioning

confidence: 81%

“… 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 …”

mentioning

confidence: 99%

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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“…Several studies investigating the postoperative range of motion reported that deltoid abduction effectiveness increases up to 30% compared to the native anatomy [ 21 , 24 , 25 ]. In RTSA, the deltoid’s abduction moment arm has much greater fluctuation, peaking at 90° of abduction, the position at which the weight of the arm creates its greatest adducting moment [ 3 , 18 , 26 ]. Hamilton et al stated that, especially in patients with rotator cuff tear arthropathy, only the posterior deltoid is left to assist with external rotation [ 27 ].…”

Section: Biomechanical Considerationsmentioning

confidence: 99%

The Evolution of Reverse Total Shoulder Arthroplasty—From the First Steps to Novel Implant Designs and Surgical Techniques

Frank

Siegert

Plachel

et al. 2022

JCM

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Purpose of Review: The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. Recent findings: Over the past decade, worldwide implantation rates of reverse total shoulder arthroplasty have drastically increased for various shoulder pathologies. While Paul Grammont’s design principles first published in 1985 for reverse total shoulder arthroplasty remained unchanged, several adjustments were made to address postoperative clinical and biomechanical challenges such as implant glenoid loosening, scapular notching, or limited range of motion in order to maximize functional outcomes and increase the longevity of reverse total shoulder arthroplasty. However, the adequate and stable fixation of prosthetic components can be challenging, especially in massive osteoarthritis with concomitant bone loss. To overcome such issues, surgical navigation and patient-specific instruments may be a viable tool to improve accurate prosthetic component positioning. Nevertheless, larger clinical series on the accuracy and possible complications of this novel technique are still missing.

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Posterior and inferior glenosphere position in reverse total shoulder arthroplasty supports deltoid efficiency for shoulder flexion and elevation

Cited by 16 publications

References 31 publications

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

Reverse Total Shoulder Arthroplasty: Biomechanics and Indications

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

The Evolution of Reverse Total Shoulder Arthroplasty—From the First Steps to Novel Implant Designs and Surgical Techniques

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