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Krupp R, O'Grady C, Werner B, Wiater JM, Nyland J, Duquin T. A two-year comparison of reverse total shoulder arthroplasty mini-humeral tray and augmented mini-glenoid baseplate implants vs. standard implants. Arch Orthop Trauma Surg 2024; 144:1925-1935. [PMID: 38523239 DOI: 10.1007/s00402-024-05276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Patients who undergo reverse total shoulder arthroplasty (RTSA) are getting younger with greater function expectations. This retrospective, longitudinal study of prospectively collected data compared perceived shoulder function and strength, active shoulder mobility, radiographic evidence of scapular notching, and implant survival over the initial 2-years post-RTSA among patient groups who received either standard central fixation point liner and glenoid baseplate implants, or lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants. MATERIALS AND METHODS Patients who underwent primary RTSA using standard central fixation point liner and glenoid baseplate implants (Group 1, n = 180) were compared with patients who underwent primary RTSA using lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants (Group 2, n = 53) for active shoulder mobility, American Shoulder and Elbow Surgeons (ASES) score, perceived ability to lift 10 lbs (4.5 kg) overhead, radiographic evidence of scapular notching, and implant survival. Data was collected pre-surgery, 6-weeks, 6-months, 1-year, and 2-years post-RTSA (p ≤ 0.05). RESULTS More Group 2 patients had more complex B or C Walch glenoid morphology, while Group 1 had more A1 or A2 types (p ≤ 0.001). Group 2 had greater active shoulder flexion at 6-months, 1-year, and 2-years (p ≤ 0.018) and external rotation (in adduction) at 6-months and 2-years (p ≤ 0.004) compared to Group 1, with higher ASES scores at 6-months and 2-years (p ≤ 0.026) (with small-to-medium effect sizes), and with more patients meeting or exceeding the minimal clinically important difference (MCID) at 2-years (p = 0.045) and patient acceptable symptomatic state (PASS) levels at 6-months, 1-year and 2-years (p ≤ 0.045). Scapular notching was identified in six of 53 (11.3%) Group 2 patients and in 32 of 180 (17.7%) Group 1 patients. Group 1 patients had more grade 2 or greater scapular notching grades compared to Group 2 (p = 0.04). Implant survival was comparable with Group 1 = eight of 180 (4.4%) and Group 2 = 1 of 53 (1.9%) of patients requiring removal for 95.6% and 98.1% implant survival, respectively. CONCLUSION Limited scapular notching and excellent implant survival was observed in both groups. Despite including individuals with more complex glenoid deficiency, patients receiving the lower size profile implants generally displayed better active shoulder mobility and perceived shoulder function compared to those who received standard implants. These patients also more frequently met or exceeded the MCID by 2-years post-RTSA and PASS levels by 6-months, 1-year, and 2-years post-RTSA, with lower scapular notching grades. LEVEL OF EVIDENCE Retrospective comparative study.
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Affiliation(s)
- Ryan Krupp
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA
| | | | - Brian Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - John Nyland
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA.
| | - Thomas Duquin
- Department of Orthopaedics, State University of New York at Buffalo, Buffalo, NY, USA
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Yildiz TI, Kara D, Demirci S, Sevinç C, Ulusoy B, Eraslan L, Aksoy T, Huri G, Duzgun I. Recovery of the shoulder kinematics after reverse shoulder arthroplasty. Clin Biomech (Bristol, Avon) 2023; 107:106013. [PMID: 37267895 DOI: 10.1016/j.clinbiomech.2023.106013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND There is very limited information about the changes in shoulder kinematics in patients with reverse shoulder arthroplasty. The aim of the study was to investigate the changes in the scapulohumeral rhythm and shoulder kinematics over time after the reverse shoulder procedure. METHODS Nineteen patients with reverse shoulder arthroplasty (age: 65.8 ± 10.3 years) were included to the study. During arm elevation in the sagittal and scapular planes, operated shoulder kinematics (humerothoracic elevation, glenohumeral elevation, scapulohumeral rhythm, and scapular rotations) were assessed using an electromagnetic tracking system at the postoperative 3rd, 6th, and 18th months. Asymptomatic shoulder kinematics were also assessed at the postoperative 18th month. Shoulder function was assessed using The Disabilities of the Arm Shoulder and Hand score at the postoperative 3rd, 6th, and 18th months. FINDINGS Maximum humerothoracic elevation increased from 98° to 109° over the postoperative period (p = 0.01). The scapulohumeral rhythm was similar on the operated and asymptomatic shoulders at the final follow-up (p = 0.11). Both the operated and asymptomatic shoulder demonstrated similar scapular kinematics at the postoperative 18th month (p > 0.05). The Disabilities of the Arm Shoulder and Hand score decreased over time in the postoperative period (p < 0.05). INTERPRETATION Shoulder kinematics may be improved after reverse shoulder arthroplasty in the postoperative period. Focusing on scapular stabilization and deltoid muscle control in the postoperative rehabilitation program may enhance the shoulder kinematics and upper extremity function.
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Affiliation(s)
- Taha Ibrahim Yildiz
- Afyonkarahisar Saglik Bilimleri University, Institution of Health Science, Turkey.
| | - Dilara Kara
- Hacettepe University, Institution of Health Science, Turkey
| | - Serdar Demirci
- Balikesir University, Institution of Health Science, Turkey
| | - Ceyda Sevinç
- Hacettepe University, Institution of Health Science, Turkey
| | - Burak Ulusoy
- Cankiri University, Institution of Health Science, Turkey
| | - Leyla Eraslan
- Hacettepe University, Institution of Health Science, Turkey
| | - Taha Aksoy
- Hacettepe University, Institution of Health Science, Turkey
| | - Gazi Huri
- Hacettepe University, Institution of Health Science, Turkey
| | - Irem Duzgun
- Hacettepe University, Institution of Health Science, Turkey
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Lu Z, Nazari G, Almeida PH, Pontes T, MacDermid JC. The clinical outcome of physiotherapy after reversed shoulder arthroplasty: a systematic review. Disabil Rehabil 2022; 44:6997-7008. [PMID: 34618652 DOI: 10.1080/09638288.2021.1985633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this systematic review was to analyze the current literature on the clinical outcomes of physiotherapy (PT) program after reversed total shoulder arthroplasty (rTSA) and to summarize the improvements in this population. METHODS A search was performed in four databases (MEDLINE, Embase, PubMed, Google Scholar) from its inception to 30 April 2020. Data were extracted to describe the study design and rehab programs. The quality of evidence was assessed as high, moderate, and low-level according to the Evaluation of Quality of an Intervention Study critical appraisal criteria. RESULTS There were 22 eligible studies including two randomized controlled trials, four prospective cohort studies, 10 retrospective reviews, five case-series, and one case-control study, with the sample sizes ranging from 9 to 474 patients followed for 1-10 years. All studies indicated substantial improvement in patients after PT program in terms of functional outcomes and forward flexion. CONCLUSIONS High-quality RCTs are required to provide more conclusive results. We identified substantial variation in the post-operative PT programs except for the progressive mobilization strategy and the common management following surgery to increase the soft tissue healing within 4-6 weeks.Implications for RehabilitationThe reverse shoulder arthroplasty (rTSA) has been widely utilized for patients with rotator cuff arthropathy, primary arthritis, and proximal fractures.A successful outcome of rTSA is not only depending on the surgical management, but also depended on physiotherapy (PT) programs.Our systematic review concluded that a 12-week PT program starting with immobilization for 4-6 weeks, followed by 3-4 phases PT exercises including PROM, AAROM, AROM, and strength training was recommended as common management for patients received rTSA.Due to the huge variation in the included studies, the evidence of PT protocol in our study was not sufficient to summarize the better clinical practice suggestions regarding rTSA rehabilitation.
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Affiliation(s)
- Ze Lu
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Canada
| | - Goris Nazari
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Canada
| | - Pedro H Almeida
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada
| | - Tatiana Pontes
- Occupational Studies, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Joy C MacDermid
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Canada.,School of Physical Therapy, Faculty of Health Science, Western University, London, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Canada
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Aliaj K, Lawrence RL, Bo Foreman K, Chalmers PN, Henninger HB. Kinematic coupling of the glenohumeral and scapulothoracic joints generates humeral axial rotation. J Biomech 2022; 136:111059. [PMID: 35367838 PMCID: PMC9081276 DOI: 10.1016/j.jbiomech.2022.111059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/22/2021] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Glenohumeral and scapulothoracic motion combine to generate humerothoracic motion, but their discrete contributions towards humerothoracic axial rotation have not been investigated. Understanding their contributions to axial rotation is important to judge the effects of pathology, surgical intervention, and physiotherapy. Therefore, the purpose of this study was to investigate the kinematic coupling between glenohumeral and scapulothoracic motion and determine their relative contributions towards axial rotation. Twenty healthy subjects (10 M/10F, ages 22-66) were previously recorded using biplane fluoroscopy while performing arm elevation in the coronal, scapular, and sagittal planes, and external rotation in 0° and 90° of abduction. Glenohumeral and scapulothoracic contributions towards axial rotation were computed by integrating the projection of glenohumeral and scapulothoracic angular velocity onto the humeral longitudinal axis, and analyzed using one dimensional statistical parametric mapping and linear regression. During arm elevation, scapulothoracic motion supplied 13-20° (76-94%) of axial rotation, mainly via scapulothoracic upward rotation. The contribution of scapulothoracic motion towards axial rotation was strongly correlated with glenohumeral plane of elevation during arm elevation. During external rotation, scapulothoracic motion contributed 10° (8%) towards axial rotation in 0° of abduction and 15° (15%) in 90° of abduction. The contribution of scapulothoracic motion towards humerothoracic axial rotation could explain the simultaneous changes in glenohumeral plane of elevation and axial rotation associated with some pathologies and surgeries. Understanding how humerothoracic motion results from the functional coupling of scapulothoracic and glenohumeral motions may inform diagnostic and treatment strategies by targeting the source of movement impairments in clinical populations.
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Postoperative malrotation of humerus shaft fracture causes degeneration of rotator cuff and cartilage. Sci Rep 2021; 11:18596. [PMID: 34545141 PMCID: PMC8452695 DOI: 10.1038/s41598-021-98040-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
We hypothesized that postoperative malrotation of humeral shaft fractures can alter the bio-mechanical environment of the shoulder; thus, rotator cuff and cartilage degeneration could be induced. Therefore, we designed an animal experiment to evaluate the impact of malrotation deformities after minimally invasive surgery for humeral fractures on the rotator cuff and cartilage, which has rarely been described in previous studies. Twenty-four New Zealand white rabbits were randomly divided into the sham control group (A), negative control group (B) and malrotated group (C). A sham operation with surgical exposure alone was performed in group A. Humeral shaft osteotomy was performed in Group B and C. In Group B, the fractures were fixed in situ with plate -screw system. While in Group C, iatrogenic rotational deformity was created after the proximal end of the fracture being internally rotated by 20 degrees and then subsequently fixed. The animals with bone healing were sacrificed for pathological and biochemical examination. In group C, the modified Mankin scale for cartilage pathology evaluation and the modified Movin scale for tendon both showed highest score among groups with statistical significance (P < 0.05); Disordered alignment and proportion of collagen I/III of rotator cuff were confirmed with picrosirius red staining; Transmission electron microscopy also showed ultrastructural tendon damage. Immunohistochemistry showed that both MMP-1 and MMP-13 expression were significantly higher in group C than groups A and B(P < 0.05). Minimally invasive techniques for humerus shaft fracture might be cosmetically advantageous, but the consequent postoperative malrotation could increase the risk of rotator cuff and cartilage degeneration. This conclusion is supported here by primary evidence from animal experiments.
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Hung LW, Lu HY, Chang CH, Chen TY, Wang TM, Lu TW. Effects of Internal Fixation for Mid-Shaft Clavicle Fractures on Shoulder Kinematics During Humeral Elevations. Front Bioeng Biotechnol 2021; 9:710787. [PMID: 34368104 PMCID: PMC8339802 DOI: 10.3389/fbioe.2021.710787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Mid-shaft clavicle fractures account for 35 to 44% of injuries to the shoulder girdle. There is increasing evidence to support surgical repair, but poor functional outcomes have been reported, and associated factors remain unclear. Methods The three-dimensional poses of the shoulder bones during arm elevations were measured in 15 patients treated for mid-shaft clavicle fractures by open reduction and internal fixation, and in 15 healthy controls. Results and Conclusion No significant between-side differences were found in the clavicle length after surgery (p > 0.05). The patients showed increased scapular protraction at lower elevation angles and reduced scapular retraction at higher elevation angles during frontal-plane elevations, with significantly reduced clavicle retraction (p < 0.05), with unaltered scapular rotation and tilt. The ranges of the observed changes were reduced to arm elevations at 60° and 90° in the scapular and sagittal planes. Similar changes were also found on the unaffected side, suggesting symmetrical bilateral compensation. The results suggest that shoulder kinematics in multi-plane arm elevations should be monitored for any signs of compromised bone motions following surgical treatment, and that rehabilitative training may be needed on both sides to improve the bilateral movement control of the shoulder complex.
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Affiliation(s)
- Li-Wei Hung
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Hsuan-Yu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsun Chang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsan-Yang Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
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Chen Z, Fan X, Gao Y, Zhang J, Guo L, Chen S, Jin Z. Effect of Rotator Cuff Deficiencies on Muscle Forces and Glenohumeral Contact Force After Anatomic Total Shoulder Arthroplasty Using Musculoskeletal Multibody Dynamics Simulation. Front Bioeng Biotechnol 2021; 9:691450. [PMID: 34291041 PMCID: PMC8287529 DOI: 10.3389/fbioe.2021.691450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Anatomic total shoulder arthroplasty (ATSA) is widely used to treat the diseases of the glenohumeral (GH) joint. However, the incidence of rotator cuff tears after ATSA increases during follow-up. The effects of rotator cuff deficiencies after ATSA on the biomechanics of the GH joint are to be investigated. In this study, a musculoskeletal multibody dynamics model of ATSA was established using a force-dependent kinematics (FDK) method. The biomechanical effects were predicted during arm abduction under different rotator cuff deficiencies. The deltoid forces were increased under the rotator cuff deficiencies, the maximum deltoid forces were increased by 36% under the subscapularis deficiency and by 53% under the supraspinatus, infraspinatus, subscapularis, and teres minor deficiencies. The maximum GH contact forces were decreased by 11.3% under supraspinatus and infraspinatus deficiencies but increased by 24.8% under subscapularis deficiency. The maximum subscapularis force was decreased by 17% under only infraspinatus tear during arm abduction. The results suggested that the changes in the biomechanics of the GH joint induced by rotator cuff deficiencies after ATSA increase the deltoid muscle energy expenditure and joint instability, which result in postoperative less satisfactory clinical outcomes. The changes in rotator cuff muscle forces deserve more attention for understanding the evolution of rotator cuff tear after ATSA.
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Affiliation(s)
- Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, China
| | - Xunjian Fan
- Institute of Mechanical Manufacturing Technology, China Academy of Engineering Physics, Mianyang, China
| | - Yongchang Gao
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, China
| | - Jing Zhang
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, China
| | - Lei Guo
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, China
| | - Shibin Chen
- Key Laboratory of Road Construction Technology and Equipment of MOE, Chang'an University, Xi'an, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom.,Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
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Merolla G, Cuoghi F, Athwal GS, Parel I, Filippi MV, Cutti AG, Fabbri E, Padolino A, Paladini P, Catani F, Porcellini G. A kinematic and electromyographic comparison of a Grammont-style reverse arthroplasty combined with a l'Episcopo transfer compared to a lateralized humeral component reverse for restoration of active external rotation. INTERNATIONAL ORTHOPAEDICS 2021; 45:2061-2069. [PMID: 34212229 DOI: 10.1007/s00264-021-05122-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess kinematic and electromyographic findings of two designs of reverse total shoulder arthroplasty (RTSA). We tested two hypotheses: (H1) Grammont-style (RTSA) with l'Episcopo tendon transfer gains similar postoperative kinematic findings of a lateralized humeral component RTSA without a tendon transfer; (H2) RTSA with lateralized humeral component induces earlier shoulder muscle activation during shoulder motion compared with standard Grammont prosthesis with l'Episcopo transfer. METHODS Twenty-five patients with a cuff tear arthropathy, pseudoparalysis, and a positive dropping sign were sequentially included. A Grammont-style RTSA with a l'Episcopo tendon transfer was implanted in 13 patients (medialized humerus and transfer group) and an on-lay curved-stem RTSA in 12 (lateralized humerus group). Constant score; the disabilities of the arm, shoulder, and hand (DASH) score; and active shoulder range of motion (flexion, abduction, external rotation, and internal rotation) were measured pre- and postoperatively. Upper limb kinematic and surface electromyography (EMG) (anterior and posterior deltoid; upper, middle, and lower trapezius; and the upper and lower latissimus dorsi muscles) were recorded during active range of motion. RESULTS At > 24 months of follow-up, the Constant and DASH scores and active shoulder range of motion improved in both groups (p < 0.0001). Internal rotation was significantly higher in the lateralized humerus group than in the medialized humerus and transfer group (p = 0.004). The dropping sign was found in 0/12 patients in the lateralized humerus group and in 5/13 patients in the medialized humerus and transfer group (p < 0.001). Kinematic findings were similar between groups (p = 0.286). A pattern of earlier muscle activation in the lateralized humerus group was found as compared to the transfer group as follows: (i) posterior deltoid during external rotation (p = 0.004); (ii) upper latissimus dorsi and middle and lower trapezius during flexion (p = 0.004, p = 0.005, and p = 0.042, respectively); (iii) lower latissimus dorsi during abduction (p = 0.016). CONCLUSION RTSA with a lateralized humeral component provided similar active external rotation restoration to a Grammont-style RTSA with a l'Episcopo procedure in patients with a dropping sign. The posterior deltoid muscle underwent earlier activation during active external rotation in the lateralized humerus RTSA group as compared to the tendon transfer group. Our findings demonstrated the H1 and only partially demonstrated the H2 of the study.
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Affiliation(s)
- Giovanni Merolla
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL Romagna, Via L. v. Beethoven 5, Code: 47841, Cattolica, Italy.
- Biomechanics Laboratory, Cervesi Hospital, Cattolica - AUSL Romagna, Cattolica, Italy.
- International Doctorate School (PhD) in Clinical and Experimental Medicine, Modena, Italy.
| | - Francesco Cuoghi
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
| | - George S Athwal
- St Joseph's Hospital, Roth McFarlane Hand & Upper Limb Center, London, ON, Canada
| | - Ilaria Parel
- Biomechanics Laboratory, Cervesi Hospital, Cattolica - AUSL Romagna, Cattolica, Italy
| | - Maria V Filippi
- Functional Recovery and Rehabilitation Unit - AUSL Romagna, Forlì, Italy
| | | | | | - Antonio Padolino
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL Romagna, Via L. v. Beethoven 5, Code: 47841, Cattolica, Italy
| | - Paolo Paladini
- Shoulder and Elbow Unit, Cervesi Hospital, Cattolica - AUSL Romagna, Via L. v. Beethoven 5, Code: 47841, Cattolica, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Porcellini
- Department of Orthopaedics and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
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Scapulohumeral rhythm in patients after total shoulder arthroplasty compared to age-matched healthy individuals. Gait Posture 2020; 82:38-44. [PMID: 32882516 DOI: 10.1016/j.gaitpost.2020.08.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/21/2019] [Accepted: 08/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The coordination of the glenohumeral joint and the shoulder girdle has been known as scapulohumeral rhythm. The effects of anatomical total shoulder arthroplasty (aTSA) are still subject to research. Former studies showed a higher amount of scapula lateral rotation to compensate for reduced glenohumeral elevation. The purpose of the present study was to confirm this mechanism and examine additional effects on the sternoclavicular and acromioclavicular joints' kinematics. METHODS 3D motion analysis was used to examine 23 shoulders of 16 patients with a mean age of 71.2 (SD: 5.2) years with a mean follow up of 5.4 (SD: 2.1) years after aTSA and to compare kinematics and coordination to 22 shoulders of 11 healthy age-matched individuals with a mean age of 69.6 (SD: 5.3) years while performing elevation movement in frontal and sagittal plane. RESULTS The ratio of glenohumeral to shoulder girdle contribution was reduced compared to healthy individuals: Shoulder girdle contribution to elevation was 36.5% (SD: 8.1) in the aTSA group vs. 28.5% (SD: 8.2) in the control group in the sagittal plane and 38.1% (SD: 9.1) vs. 30.2% (SD: 7.1) in the frontal plane. Kinematics of the sternoclavicular and acromioclavicular joints showed significantly different patterns. CONCLUSION Patients after aTSA showed altered shoulder girdle kinematics and higher contribution of the shoulder girdle towards elevation. Whether this is a result of the surgery, of limited glenohumeral range of motion or due to the preoperative status remains unclear. Further investigation with a prospective study design is necessary.
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