The SMR reverse shoulder prosthesis in the treatment of cuff-deficient shoulder conditions

Young, Simon W.; Everts, N.; Ball, Craig M.; Astley, T.; Poon, Peter C.

doi:10.1016/j.jse.2009.01.017

Cited by 65 publications

(36 citation statements)

References 23 publications

(17 reference statements)

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“…Despite a superior tilt of the baseplate, this patient had good functional result at the latest follow-up, with a ConstantMurley score of 63 (90 %), no pain, and a satisfactory active range of motion. Active flexion was 130°, active external rotation 90°, shoulder abduction 60°and internal rotation to the level of T12 scapular notching [50]. Edwards et al [13], in a randomised study, found that inferior glenoid tilt did not decrease scapular notching.…”

Section: Discussionmentioning

confidence: 97%

“…Boughrebi et al [4] suggested a more posterior predesigned notch. Another bias in studies of scapular notching is that different classifications of scapular notches are imprecise due to the variable direction of inferior screws among different prosthetic designs, or even in the same arthroplastic design where nonlocking screws can have different directions [50]. This changes the distance between the inferior screw and the scapular pillar; therefore, we feel that the best way to determine whether a notch is benign and nonevolutive is the presence of densification at the bottom of the notch.…”

Section: Discussionmentioning

confidence: 99%

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Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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Purpose Our purpose was to evaluate the influence of metallic lateralisation of the centre of rotation (COR) in reverse shoulder arthroplasty (RSA) on the incidence of scapular notching and its eventual clinical and radiological consequences. Methods We analysed 140 RSAs with a lateralised design (Arrow, FH Orthopedics, Mulhouse, France) implanted for massive rotator cuff tear with/without arthritis. Mean followup was 45 months (range 24-120, standard deviation 20). Patients were evaluated clinically using the Constant and Murley (Clin Orthop Relat Res 214:160-164, 1987) score and active range of motion (ROM) and radiologically using standard anteroposterior and axillary view. Scapular notching was assessed according to Sirveaux classification Simovitch et al. (J Bone Joint Surg Am, 89:588-600, 2007), and patients were separated into two groups (scapular notch/no scapular notch) and compared. Results Forty-one notches (29 %) were found: 20 grade 1, 18 grade 2, and three grade 3. The latter three patients had a follow-up of 44, 70 and 84 months, respectively, and the scapular notch did not evolve in the final two years. Better preoperative function was significantly associated with scapular notching (p<0,05 for flexion and abduction), but no final clinical differences in ROM and Constant score were found between groups. A body mass index (BMI) <30 increased the risk of scapular notching, which was observed in 43 % of patients with a BMI<30 and 30 % of patients with a BMI> 30 p=0,048). Pre-operative narrowing of the subacromial space increased the risk of scapular notching, but age or gender showed no influence. However, there was a significantly greater number of scapular notches in patients operated on the dominant side (p=0,04). No significant difference in lateral offset was found between groups (p=0,99). Glenoid implantation in an excessively high position (p=0,033) and absence of inferior tilt (p=0,0029) were significantly associated with scapular notching. Conclusions In this series, metallic lateralisation of the COR in RSA did not impair clinical results, with patients achieving good flexion recovery ROM increase in rotations. Metallic lateralisation of the COR in RSA leads to a lower incidence of scapular notching (29 %) compared with previously reported results using other arthroplastic systems with a more medialised COR. However, although scapular notching was not totally eliminated, those that were found did not evolve over time. Several factors increased the incidence of scapular notching: BMI <30, better preoperative ROM, an excessively high glenoid implant and absence of inferior tilt.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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“…Any procedure addressing shoulder reconstruction with RTSA demands the existence of a functional deltoid muscle that makes shoulder mobility possible with this type of implant [20]. The major indication for using RTSA is arthritis associated with massive rotator cuff tears which accounts for approximately 90 % of the cases in different series [2,5,6,8,9,22]. The patient's age is important for the indication, as the implant longevity is not well understood; therefore, most authors do not advocate use of this type of implant for patients under 65 years of age [1,5,9,[23][24][25][26].…”

Section: Indicationsmentioning

confidence: 99%

Complications with reverse total shoulder arthroplasty and recent evolutions

Scarlat¹

2013

International Orthopaedics (SICOT)

121

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Since its description by Paul Grammont from Dijon, France, several tens of thousands of reverse total shoulder arthroplasties (RTSA) have been performed for diverse conditions. The purpose of this analysis is to identify the complications of this procedure in the literature and in clinical practice. A total of 240 papers concerning RTSA published between 1996 and 2012 have been identified. Over 80 papers describe complications associated with this type of implant. A list of prostheses satisfying European and US standards, CE and FDA approved, has been produced on the basis of information provided by the manufacturers. Data from the literature do not support a meta-analysis. The inventory of best practices shows excellent results in the short and medium term in specific indications, while the number of complications varies between 10 and 65 % in long-term series. Complications can be classified into (A) non-specific including infections (superficial and deep), phlebitis, haematoma, neurological complications of the suprascapular, radial and axillary nerves and (B) specific complications associated with RTSA including (1) on the glenoid side: intraoperative fracture of the glenoid and acromion, late fracture of the scapula, impingement at the scapular neck (notching), glenoid loosening, dissociation of the glenoid component (snatching of the glenosphere) and fractures of the glenoid baseplate; (2) on the humeral side: metaphyseal deterioration, humeral loosening, instability of the shoulder, stiffness with limitation of external and/or internal rotation; and (3) muscular complications with fatty degeneration of the deltoid. Additionally we have identified specific situations related to the type of implant such as the disassembly of the humeral or the glenoid component, dissociation of the polyethylene humeral plate, dissociation of the metaphysis and osteolysis of the tuberosities. The integration of results from different clinical series is difficult because of the lack of a database and the multitude of implants used.

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“…[24][25][26] These findings have a major clinical significance because improved adduction may reduce mechanical impingement and hence the risk of scapular notching; they also have important implications in terms of long-term functional outcomes and durable fixation of the glenoid component. 17,26,27 A causal correlation between inferior scapular notching and poor clinical outcomes has been under discussion in the literature. Simovitch et al reported that inferior scapular notching is associated with a lower mean relative CS and a lower subjective shoulder value, as well as a lower post-operative active flexion and abduction, in a study on 77 shoulders at a mean followup of 44 months (range 24 months to 96 months).…”

Section: Discussionmentioning

confidence: 99%

“…It can be also associated with the development of an osteolytic process as a result of wear debris of the polyethylene liner. 15 Scapular notching has been frequently reported after RTSA, although with different incidence values, either as completely absent 16,17 or ranging from 44% to 96%. 4,12,13 The aim of this retrospective study was to compare the incidence of scapular notching, ROM, pain and implant stability after RTSA with glenospheres of different design (standard and eccentric) and materials [cobalt-chromium-molybdenum (CoCrMo) and crosslinked ultra-high molecular weight polyethylene (X-UHMWPE)].…”

Section: Introductionmentioning

confidence: 99%

Influence of glenosphere design and material on clinical outcomes of reverse total shoulder arthroplasty

Bloch¹,

Budassi

Bischof

et al. 2014

Shoulder & Elbow

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Background: The aim of this multicentre retrospective study was to compare reverse total shoulder arthroplasty clinical outcomes with glenospheres of different diameters, designs and materials. Methods: Between 2003 and 2008, 133 patients were divided into three groups: 60 (45%) with 36-mm standard CoCrMo (group A), 21 (16%) with 36-mm eccentric cobalt-chromium-molybdenum (CoCrMo) (group B) and 52 (39%) with 44-mm cross-linked ultra-high molecular weight polyethylene (X-UHMWPE) (group C) glenospheres. Mean (SD) follow-up was 38.7 (17.4) months. Clinical evaluation included Constant score and range of motion. Radiographic analysis included radiolucent lines, instability, loosening and assessment of scapular notching. Results: Mean Constant score significantly increased for all groups (Wilcoxon test, p < 0.001). Group C allowed a higher and stable increase in range of motion. After 12 months and 24 months, groups C and B showed less pain than group A (Mann-Whitney U-test, p < 0.05). Group C had significantly lower scapular notching than group B (MannWhitney U-test, p ¼ 0.001) and A (Mann-Whitney U-test, p ¼ 0.009) at 12 months, 24 months and 36 months. Groups A and C presented 5 (8.3%) and 4 (7.6%) early complications, respectively. Conclusions: The present study reported good results for all groups, although groups C and A presented better clinical outcomes, significantly lower notching and instability. A 44-mm X-UHMWPE glenosphere allowed a faster and more stable functional recovery, despite poorest pre-operative conditions. Additional long-term studies are needed to evaluate survivorship.

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The SMR reverse shoulder prosthesis in the treatment of cuff-deficient shoulder conditions

Cited by 65 publications

References 23 publications

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Complications with reverse total shoulder arthroplasty and recent evolutions

Influence of glenosphere design and material on clinical outcomes of reverse total shoulder arthroplasty

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