The relationship between glenoid inclination and instability following primary reverse shoulder arthroplasty

Bechtold, Daniel; Ganapathy, Pramodh K.; Aleem, Alexander W.; Chamberlain, Aaron M.; Keener, Jay D.

doi:10.1016/j.jse.2020.09.037

Cited by 14 publications

(15 citation statements)

References 21 publications

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“…Studies assessing other methods of glenoid inclination have similarly found little to no association between glenoid inclination and complications. 22,23 These results may reflect that glenoid baseplates were placed within an acceptable range of PSNA and did not extend to extreme inclinations which would result in unfavorable biomechanics and short-term complications. 28,39 Future studies are needed to investigate if an increased rate of complications in patients with certain baseplate inclination occur with longer follow-up.…”

Section: Discussionmentioning

confidence: 96%

“…16,27,37 Recent studies have repeatedly demonstrated that inferior tilt provides no ROM or clinical outcome score benefits relative to neutral or superior tilt in the short term. [21][22][23][24] In a prospective randomized controlled study by Edwards and colleagues, 52 patients were randomized to receive neutral or inferiorly tilted glenospheres. On postoperative follow-up (average, 21 months), patients randomized to receive inferiorly tilted glenospheres did not have reduced incidence or severity of notching, improved ROM (FE, abduction, ER, or IR), or ASES score.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with recent retrospective reviews by Bechtold et al, Mahendraraj et al, and Werner et al that show inclination does not significantly influence outcomes. [22][23][24] The remaining literature insufficiently describes the impact of baseplate tilt on postoperative functional outcomes, with studies focusing solely on radiographic evidence of complication or inadequately documenting postoperative glenosphere inclination in relation to long-term functional outcomes. 10,15,18,[25][26][27][28] Minimal data exists to guide surgeons in determining the ideal glenosphere inclination or prosthesis scapular neck angle (PSNA) in order to optimize patient outcomes and limit complications.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between the prosthesis scapular neck angle and clinical outcomes in reverse shoulder arthroplasty

et al. 2023

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Background Optimal glenosphere positioning in reverse shoulder arthroplasty (RSA) remains highly debated. We aimed to characterize the association between the prosthesis scapular neck angle (PSNA) and postoperative range of motion (ROM) and clinical outcome scores. Methods A retrospective review of 284 RSAs using a single design with minimum 2-year follow-up was performed. Glenosphere tilt was measured postoperatively using PSNA. ROM and functional outcome scores were assessed preoperatively and at latest follow-up. The PSNA was dichotomized to inferior or superior groups (>90° vs ≤ 90°, respectively) and stratified into quartiles; ROM and outcome score measures were compared between groups controlling for inferior glenosphere overhang. Results No range of PSNA was consistently associated with superior ROM, clinical outcome scores, or rates of complications including scapular notching. However, greater preoperative to postoperative improvement in active FE was found for superiorly (PSNA ≤ 90°) versus inferiorly tilted glenospheres (37° ± 33° vs 53° ± 35°, P = 0.005) and the greater improvement in active FE (57° ± 35°, P = 0.004) was further isolated to the first quartile (mean 85.1° ± 3.5°). Discussion A lack of variation in clinical outcomes based on PSNA suggests negligible short-term (median follow-up 3.1 years) clinical significance when glenosphere tilt falls within the distribution of this cohort (mean 92.6° ± 6.2°).

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship between the prosthesis scapular neck angle and clinical outcomes in reverse shoulder arthroplasty

et al. 2023

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“…Although the available literature is divided on whether the preoperative diagnosis is a risk factor for instability, sex, body mass index, and surgical technique are established factors. An aggressive humeral cut, superior glenoid positioning, superior glenosphere inclination, subscapularis repair, and subsequent subscapularis integrity are known surgical missteps that can increase the chance of instability after an RSA [14]. Therefore, attention to surgical details such as soft tissue release and intraoperative assessments of stability are important, regardless of the etiology.…”

Section: Discussionmentioning

confidence: 99%

Short-term comparative outcomes between reverse shoulder arthroplasty for shoulder trauma and shoulder arthritis: a Southeast Asian experience

Tham

Kolla

et al. 2022

Clin Shoulder Elbow

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Background: Reverse shoulder arthroplasty (RSA), first introduced as a management option for cuff tear arthropathy, is now an accepted treatment for complex proximal humeral fractures. Few studies have identified whether the outcomes of RSA for shoulder trauma are comparable to those of RSA for shoulder arthritis. Methods: This is a retrospective, single-institution cohort study of all patients who underwent RSA at our institution between January 2013 and December 2019. In total, 49 patients met the inclusion criteria. As outcomes, we evaluated the 1-year American Shoulder and Elbow Surgeons (ASES) and Constant shoulder scores, postoperative shoulder range of motion, intra- and postoperative complications, and cumulative revision rate. The patients were grouped based on preoperative diagnosis to compare postoperative outcomes across two broad groups. Results: The median follow-up period was 32.8 months (interquartile range, 12.6–66.6 months). The 1-year visual analog scale, range of motion, and Constant and ASES functional scores were comparable between RSAs performed to treat shoulder trauma and that performed for arthritis. The overall complication rate was 20.4%, with patients with a preoperative diagnosis of arthritis having significantly more complications than those with a preoperative diagnosis of trauma (34.8% vs. 7.7%). Conclusions: Patients who underwent RSA due to a proximal humeral fracture or dislocation did not fare worse than those who underwent RSA for arthritis at 1 year, in terms of both functional and radiological outcomes.

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“…However, inclination is a critical factor in our daily practice for diagnosis and classification and is highly involved in certain surgical planning and decision [ 8 , 9 , 10 ]. Several studies also report that implants inclination in reverse shoulder arthroplasty has been proven to have a direct impact on the clinical outcomes, such as prosthetic stability [ 11 , 12 ], or glenohumeral kinetics and patients’ final motions [ 13 , 14 ]. Thus, we assume those differences must be analyzed in the light of various reference systems that generate the scapula’s transverse axis.…”

Section: Introductionmentioning

confidence: 99%

Glenoid Inclination: Choosing the Transverse Axis Is Critical—A 3D Automated versus Manually Measured Study

Gauci

Jacquot²,

Casson

et al. 2022

JCM

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The aim of this study was to evaluate the variation in measured glenoid inclination measurements between each of the most used methods for measuring the scapular transverse axis with computed tomography (CT) scans, and to investigate the underlying causes that explain the differences. Methods: The glenoid center, trigonum and supraspinatus fossa were identified manually by four expert shoulder surgeons on 82 scapulae CT-scans. The transverse axis was generated either from the identified landmarks (Glenoid-Trigonum line (GT-line), Best-Fit Line Fossa (BFLF)) or by an automatic software (Y-axis). An assessment of the interobserver reliability was performed. We compared the measured glenoid inclination when modifying the transverse axis to assess its impact. Results: Glenoid inclination remained stable between 6.3 and 8.5°. The variations occurred significantly when changing the method that determined the transverse axis with a mean biase from −1.7 (BFLF vs. Y-axis) to 0.6 (BFLF vs. GT-line). The Y-axis method showed higher stability to the inclination variation (p = 0.030). 9% of cases presented more than 5° of discrepancies between the methods. The manual methods presented a lower ICC (BFLF = 0.96, GT-line = 0.87) with the widest dispersion. Conclusion: Methods that determine the scapular transverse axis could have a critical impact on the measurement of the glenoid inclination. Despite an overall good concordance, around 10% of cases may provide high discrepancies (≥5°) between the methods with a possible impact on surgeon clinical choice. Trigonum should be used with caution as its anatomy is highly variable and more than two single points provide a better interrater concordance. The Y-axis is the most stable referential for the glenoid inclination.

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The relationship between glenoid inclination and instability following primary reverse shoulder arthroplasty

Cited by 14 publications

References 21 publications

Relationship between the prosthesis scapular neck angle and clinical outcomes in reverse shoulder arthroplasty

Relationship between the prosthesis scapular neck angle and clinical outcomes in reverse shoulder arthroplasty

Short-term comparative outcomes between reverse shoulder arthroplasty for shoulder trauma and shoulder arthritis: a Southeast Asian experience

Glenoid Inclination: Choosing the Transverse Axis Is Critical—A 3D Automated versus Manually Measured Study

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