The role of greater tuberosity healing in reverse shoulder arthroplasty: a finite element analysis

Sabesan, Vani J.; Lima, Diego J.L.; Yang, Yang; Stankard, Matthew; Drummond, Mauricio; Liou, William W.

doi:10.1016/j.jse.2019.07.022

Cited by 15 publications

(13 citation statements)

References 35 publications

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“…The significant and moderate correlation between the union of the GT and external rotation in this series ( p = 0.006, r = 0.431) confirms the results of previous studies 8–11,37 …”

Section: Discussionsupporting

confidence: 90%

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Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Doll

Neide

Mick

et al. 2022

Journal Orthopaedic Research

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Functional outcome after reverse-shoulder-arthroplasty (RSA) in proximal humerus fractures (PHF) depends on deltoid muscle integrity and successful reattachment of the tuberosities for best possible recovery of rotator-cuff function. In this monocentric, prospective, randomized, controlled trial we investigated whether a reverse-fracture-prosthesis (RFP) with a metaphyseal fenestrated stem achieved superior shoulder and muscle function compared to a common reverse-prosthesis (RP) design for patients with PHF. Our hypothesis was that patients with RFP may achieve a superior healing rate of the greater tuberosity (GT) compared to patients receiving RP, which translates to significantly higher clinical outcome and functional scores as well as differences in deltoid muscle microperfusion. Forty-four patients with PHF were randomized preoperatively to one of the prosthesis types in RSA between 2018 and 2020 (22 with RFP and 22 with RP) and prospectively assessed 6 months after surgery. We assessed osteointegration of the GT with radiographs 1 day and 6 months postoperatively and examined shoulder function and patient satisfaction by using established shoulder scores. A contrast-enhanced ultrasound (CEUS) examination of both shoulders was performed to quantify intramuscular blood flow and evaluate vitality of the deltoid muscle. None of the functional and psychosocial scores or radiographs and ultrasound examinations showed significant differences between the RSA designs. The constant-Murley score (p = 0.384) and active anterior-elevation-abduction, and external rotation were comparable between the RFP and RP group. Similar healing rates of the GT were observed (p = 0.655).CEUS-assessed deltoid microperfusion revealed equivalent muscle vitality for both groups (p = 0.312). Level of evidence: Level II; Randomized Controlled Trial;Treatment Study. Clinical significance: The radiographic evaluation for the investigation of the GT healing rate indicates that the proclaimed benefits of the fracture prosthesis with fenestration design might not be as great as expected.

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“…The significant and moderate correlation between the union of the GT and external rotation in this series ( p = 0.006, r = 0.431) confirms the results of previous studies 8–11,37 …”

Section: Discussionsupporting

confidence: 90%

“…For this purpose, the integrity of the deltoid muscle is highly relevant to achieve acceptable results after surgery 7 . Secondly, the periprosthetic reattachment and osteointegration of the tuberosities is favored, as it is associated with restoration of active external rotation and anterior elevation 8–10 …”

Section: Introductionmentioning

confidence: 99%

Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Doll

Neide

Mick

et al. 2022

Journal Orthopaedic Research

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“…Our results also confirmed that the healed greater tuberosity groups obtained better clinical outcomes (higher CS, higher SSV, and lower DASH) and better performance in flexion, abduction, external rotation, and external rotation in 90° of abduction. However, a recent finite element analysis about the role of greater tuberosity healing in RSA indicated that greater tuberosity healing did not impact flexion and abduction of shoulder; on the contrary, it did affect the biomechanics of external rotation ( 44 ). Interestingly, most studies focus on the advantages of healing of the greater tuberosity and few studies pay attention to the differences of different types of prosthesis, which have an important impact on the healing rate of the greater tuberosity.…”

Section: Discussionmentioning

confidence: 99%

Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis

Liao

Guo

et al. 2021

Front. Surg.

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Introduction: Reverse shoulder arthroplasty (RSA) is becoming popular in the treatment of complex proximal humeral fractures (PHFs). Greater tuberosity healing may influence functional outcomes and range of motion (ROM) of shoulder after RSA. In addition, the design of prosthesis may impact the healing rate of greater tuberosity. The purpose of this study is to know: (1) does the healing of greater tuberosity affect the functional outcomes and ROM of shoulder? and (2) does the design of prosthesis affect the healing rate of greater tuberosity?Materials and Methods: PubMed, Ovid/Embase, and the Cochrane Library were searched for studies comparing the clinical outcomes between the healed groups and the non-healed groups after RSA.Results: For functional outcomes, the results showed that the healed group had better Constant scores (CSs) (p < 0.0001). For ROM, the healed group showed better flexion (p < 0.0001), abduction (p = 0.02), and external rotation (p < 0.00001) of shoulder. For the design of prosthesis, the mean healing rate of greater tuberosity (82.7%) in patients with fracture-dedicated prosthesis was higher than those (63.0%) in patients with standard prosthesis. Subgroup analyses showed that the CS (p = 0.12) and abduction (p = 0.96) of patients using fracture-dedicated prostheses were not different between the healed groups and the non-healed groups. Meta-regression showed that there was no significant relationship between the design of prosthesis and CS (p = 0.312), flexion (p = 0.422), or external rotation (p = 0.776).Conclusion: Our meta-analysis showed that the healed groups could obtain better functional outcomes and ROM than the non-healed groups. In addition, fracture-dedicated prostheses promoted the healing rate of greater tuberosity.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020157276, PROSPERO: CRD42020157276.

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“…Furthermore, with proximal humeral bone loss, the greater tuberosity can be compromised, which both shortens the deltoid abductor moment arm lengths to decrease deltoid efficiency and also reduces deltoid wrapping to increase risk of instability. Sabesan et al [ 92 ] recently reported that loss of the greater tuberosity with rTSA negatively impacts shoulder biomechanics by shortening deltoid moment arms and requiring greater muscle forces during external rotation as compared to rTSA shoulders with a greater tuberosity. For patients with humeral bone loss, humeral lateralization can be recreated through the use of a novel rTSA humeral tray that includes a tuberosity augment to reconstruct the greater tuberosity of the proximal humerus to maintain a lateral deltoid over the range of motion and increase deltoid wrapping to improve stability ( Figure 10 ).…”

Section: Rtsa Patient-specific Considerations On Biomechanicsmentioning

confidence: 99%

Reverse Shoulder Arthroplasty Biomechanics

Roche

2022

JFMK

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The reverse total shoulder arthroplasty (rTSA) prosthesis has been demonstrated to be a viable treatment option for a variety of end-stage degenerative conditions of the shoulder. The clinical success of this prosthesis is at least partially due to its unique biomechanical advantages. As taught by Paul Grammont, the medialized center of rotation fixed-fulcrum prosthesis increases the deltoid abductor moment arm lengths and improves deltoid efficiency relative to the native shoulder. All modern reverse shoulder prostheses utilize this medialized center of rotation (CoR) design concept; however, some differences in outcomes and complications have been observed between rTSA prostheses. Such differences in outcomes can at least partially be explained by the impact of glenoid and humeral prosthesis design parameters, surgical technique, implant positioning, patient-specific bone morphology, and usage in humeral and glenoid bone loss situations on reverse shoulder biomechanics. Ultimately, a better understanding of the reverse shoulder biomechanical principles will guide future innovations and further improve clinical outcomes.

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The role of greater tuberosity healing in reverse shoulder arthroplasty: a finite element analysis

Cited by 15 publications

References 35 publications

Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Functional outcome and CEUS‐assessed deltoid muscle vitality after fracture‐specific versus standard prosthetic design in reverse shoulder arthroplasty for trauma

Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis

Reverse Shoulder Arthroplasty Biomechanics

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