Standard versus bony increased-offset reverse shoulder arthroplasty: a retrospective comparative cohort study

Collin, Philippe; Liu, Xin; Denard, Patrick J.; Gain, Solenn; Nowak, Alexandra; Lädermann, Alexandre

doi:10.1016/j.jse.2017.07.020

Cited by 52 publications

(73 citation statements)

References 18 publications

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“…In the same study, statistically significant difference was identified when comparing the rates of scapular notching (standard RSA 68% vs BIO-RSA 33%; p = 0.028). Another study did not show any advantage of BIO-RSA over conventional RTSA including scapular notching [15]. However, their notching rate was low (5%) as compared to our study.…”

Section: Discussioncontrasting

confidence: 84%

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Tankshali¹,

Ji²,

Park³

et al. 2020

Preprint

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Background: Bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) was proposed which uses autograft harvested from the patient’s humeral head to lateralize the glenoid baseplate. This technique provided the lateralization of the center of rotation and the reduction of the scapular notching. Few studies have reported outcomes of BIO-RSA in the Asian population. We reported the first report of clinical and radiological outcomes of BIO-RSA in the Asian population at mid-term follow-up. Methods: From June 2012 to August 2017, a total 38 patients with average age of 73±6 years operated by the BIO-RSA technique with minimum two-year follow-up (average 36.7±16 months) were enrolled in our study. Indications of the BIO-RSA were rotator cuff tear arthropathy, massive irreparable cuff tear without osteoarthritis, primary osteoarthritis with glenoid defect, recurrent shoulder dislocation with massive cuff tear, and glenoid fracture sequela. We excluded patients with acute proximal humerus fracture, avascular necrosis and revision RSA performed using allo- or autograft. We evaluated clinical and radiological outcomes of BIO-RSA at the last follow-up. Results: VAS, ASES, UCLA, and SST scores improved significantly from preoperative (average-5, 39.4, 16.2, 3.9) to postoperative (average- 1.7, 78.9, 28.3, 7.8, p-value < 0.05). All range of motion except internal rotation improved significantly at the last follow-up (p-value <0.05) and the bone graft was incorporated with the native glenoid in all the cases (100%). However, scapular notching was observed in 23/38 (60.5%) of patients. Intraoperative complications were three metaphyseal fractures and one inferior screw malpositioning. Postoperative complications included one heterotropic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection. Conclusions: BIO-RSA results in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantage of glenoid lateralization were observed in our study along with similar complications rates as compared to conventional RTSA, we observed higher rates of scapular notching to previously reported rates in BIO-RSA studies.

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Section: Discussioncontrasting

confidence: 84%

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Tankshali¹,

Ji²,

Park³

et al. 2020

Preprint

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“…Some authors found better results in terms of notching and ROM 4,21 with BIO-RSA; other comparative studies reported similar results. 1,9,21,37 Some studies reported higher complication and scapular notching rates with bone grafts compared with augmented glenoid baseplates 30 or compared with standard RSA 31 (even if in this paper of Jones et al, 31 9 of 44 cases in the BIO-RSA group were revisions, leading probably to a bias). Different from these previous studies, we used an onlay stem with a neck-shaft angle of 145 for all patients, and we found similar clinical results using or not using a lateralizing bone graft with this humeral design (Fig.…”

Section: Discussionmentioning

confidence: 77%

“…The clinical effect of glenoid lateralization combined with humeral lateralization is not clear, and the best combined solution for humerus and glenoid management is still to be understood. 9 In the literature, all the studies that compared BIO-RSA with standard RSA 1,4,9,21 used a Grammont humeral design; with this stem, there is no uniformity of results and opinions regarding the real advantage in terms of clinical outcomes and ROM given by use of lateralizing bone grafts. Some authors found better results in terms of notching and ROM 4,21 with BIO-RSA; other comparative studies reported similar results.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 Currently, the clinical effect of glenoid lateralization combined with humeral lateralization is not clear, and the best combined solution for humerus and glenoid management is still to be understood. 9 All the clinical studies 1,4,9,21 that compared standard RSA with BIO-RSA used a Grammont humeral stem design without uniformity of conclusions. Some biomechanical studies analyzed the effects of combined humeral and glenoid lateralization.…”

mentioning

confidence: 99%

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Clinical results of bony increased-offset reverse shoulder arthroplasty (BIO-RSA) associated with an onlay 145° curved stem in patients with cuff tear arthropathy: a comparative study

Franceschetti

Ranieri

Sanctis

et al. 2020

Journal of Shoulder and Elbow Surgery

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“…This equated to an overall fracture rate of 12.5%, slightly higher than that reported in previous literature [ 1 , 3 , 13 ]. This may relate to under-reporting of this complication, due to the difficulty in diagnosis [ 14 , 23 ] and failure of several key studies to report this complication [ 11 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Reverse shoulder arthroplasty vs BIO-RSA: clinical and radiographic outcomes at short term follow-up

2018

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BackgroundBony increased-offset reverse shoulder arthroplasty (BIO-RSA) may address issues such as inferior scapular notching, prosthetic instability and limited postoperative shoulder rotation; all of which have been reported with the standard RSA and attributed to the medialized design. We hypothesised that this lateralization may increase the rate of scapular stress fractures.MethodsA retrospective review of prospectively collected data was performed on patients who had undergone a RSA between January 2013 and October 2016. A comparative cohort study was designed to compare patients with a standard Grammont-style RSA to those with a BIO-RSA using the same implant. Functional outcome was measured by the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the Subjective Shoulder Value (SSV), the Western Ontario Osteoarthritis of the Shoulder (WOOS) index and pain scores. Radiographs were obtained for all patients and examined for the presence of scapular fracture as well as scapular notching and graft incorporation.ResultsA total of forty patients (22 patients in the standard RSA cohort and 18 with BIO-RSA) were included in the study. Patient characteristics (including age, gender, length of follow-up, dominant side and osteoporosis) were similar in both groups (p > 0.05). The average postoperative follow-up was 20 months (range 12–48 months). There was bone graft incorporation in all BIO-RSA patients at the final radiological follow-up, with no evidence of graft resorption. The overall scapular stress fracture rate was 12.5% (9.1% in the standard RSA and 16.7% in the BIO-RSA). The rates were similar in both cohorts (p = 0.64). All fractures were managed conservatively. To determine whether the presence of a scapular stress fracture had an influence on outcomes, the cohort was divided into cases with and without fracture. Patients with a stress fracture had worse ASES (p = 0.028) and WOOS (p = 0.048) scores. Additionally, osteoporosis was present more commonly in the fracture group (80% vs 17%; p = 0.01). A statistically significant difference was identified when comparing the rates of scapular notching between standard RSA and BIO-RSA cohorts (68% vs 33%; p = 0.028). Furthermore, when notching was present, significantly worse outcome scores were present in all outcome measures (p < 0.001).ConclusionThe BIO-RSA technique was associated with an increase in scapular stress fracture rate when compared to the standard RSA; however, this was not found to be significant. Furthermore, both techniques resulted in similar improvements in the measured functional outcomes. BIO-RSA, however, was associated with a lower scapular notching rate, justifying further evaluation of this technique.Level of evidenceRetrospective cohort study, level III

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Standard versus bony increased-offset reverse shoulder arthroplasty: a retrospective comparative cohort study

Cited by 52 publications

References 18 publications

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Clinical and Radiological Outcomes of Bony Increased Offset-Reverse Total Shoulder Arthroplasty in the Asian Population

Clinical results of bony increased-offset reverse shoulder arthroplasty (BIO-RSA) associated with an onlay 145° curved stem in patients with cuff tear arthropathy: a comparative study

Reverse shoulder arthroplasty vs BIO-RSA: clinical and radiographic outcomes at short term follow-up

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