1
|
Haase L, Ina J, Harlow E, Chen R, Gillespie R, Calcei J. The Influence of Component Design and Positioning on Soft-Tissue Tensioning and Complications in Reverse Total Shoulder Arthroplasty: A Review. JBJS Rev 2024; 12:01874474-202404000-00002. [PMID: 38574183 DOI: 10.2106/jbjs.rvw.23.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
» Reverse total shoulder arthroplasty was designed to function in the rotator cuff deficient shoulder by adjusting the glenohumeral center of rotation (COR) to maximize deltoid function.» Adjustments in the COR ultimately lead to changes in resting tension of the deltoid and remaining rotator cuff, which can affect implant stability and risk of stress fracture.» Soft-tissue balance and complication profiles can be affected by humeral component (version, neck shaft angle, and inlay vs. onlay) and glenoid component (sagittal placement, version, inclination, and lateralization) design and application.» A good understanding of the effects on soft-tissue balance and complication profile is critical for surgeons to best provide optimal patient outcomes.
Collapse
Affiliation(s)
- Lucas Haase
- University Hospitals of Cleveland, Cleveland, Ohio
| | | | | | | | | | | |
Collapse
|
2
|
Shafritz A, Mangan J, DeSarno M, Kanner CD. Mid-term results of the use of structural humeral head autograft to correct glenoid bone loss in reverse total shoulder arthroplasty. JSES Int 2024; 8:132-140. [PMID: 38312272 PMCID: PMC10837731 DOI: 10.1016/j.jseint.2023.08.018] [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] [Indexed: 02/06/2024] Open
Abstract
Background Native glenoid bone loss presents technical challenges in shoulder arthroplasty. The purpose of this study is to report the mid-term clinical and radiographic outcomes of patients treated with structural humeral head autograft reconstruction of glenoid bone loss in the setting of reverse total shoulder arthroplasty (rTSA). Methods Retrospective review of 30 shoulders in 28 patients undergoing rTSA with a structural humeral head autograft to correct glenoid bone loss. Demographics, comorbidities, anatomic details, and patient-reported outcome measures were collected for analysis. Results Range of motion and patient-reported outcome measures were all significantly improved postoperatively (P < .001). Bone grafts were found to incorporate into 100% of shoulders, with no protheses displaying signs of loosening or other structural concerns. No revision procedures were performed, and all patients were satisfied with their shoulder postoperatively. Two patients developed scapular notching on follow-up. Discussion The use of a humeral head autograft to reconstruct glenoid bone loss in patients undergoing rTSA is a safe and effective procedure. It allows for a local graft source to be utilized thus avoiding potential comorbidity and complications associated with the use of alternative site autografts or allografts and has the advantage of nearly congruent fit within the defect.
Collapse
Affiliation(s)
- Adam Shafritz
- Department of Orthopedic Surgery, University of Vermont Medical Center, Burlington, VT, USA
| | - Jack Mangan
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Michael DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Christopher D Kanner
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
| |
Collapse
|
3
|
Jomaa MN, Branni M, Ingoe H, Pareyon R, Italia K, Launay M, Salhi A, Gilliand L, Nielsen J, Maharaj J, Cutbush K, Gupta A. Does forearm referencing using a retroversion guide achieve the targeted retroversion of the humeral component in reverse shoulder arthroplasty? J Shoulder Elbow Surg 2023:S1058-2746(23)00884-4. [PMID: 38122891 DOI: 10.1016/j.jse.2023.10.038] [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: 05/24/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Component positioning affects clinical outcomes of reverse shoulder arthroplasty, which necessitates an implantation technique that is reproducible, consistent, and reliable. This study aims to assess the accuracy and precision of positioning the humeral component in planned retroversion using a forearm referencing guide. METHODS Computed tomography scans of 54 patients (27 males and 27 females) who underwent primary reverse shoulder arthroplasty for osteoarthritis or cuff tear arthropathy were evaluated. A standardized surgical technique was used to place the humeral stem in 15° of retroversion. Version was assessed intraoperatively visualizing the retroversion guide from above and referencing the forearm axis. Metal subtraction techniques from postoperative computed tomography images allowed for the generation of 3D models of the humerus and for evaluation of the humeral component position. Anatomical humeral plane and implant planes were defined and the retroversion 3D angle between identified planes was recorded for each patient. Accuracy and precision were assessed. A subgroup analysis evaluated differences between male and female patients. RESULTS The humeral retroversion angle ranged from 0.9° to 22.8°. The majority (81%) of the measurements were less than 15°. Mean retroversion angle (±SD) was 9.9° ± 5.8° (95% CI 8.4°-11.5°) with a mean percent error with respect to 15° of -34% ± 38 (95% CI -23 to -44). In the male subgroup (n = 27, range 3.8°-22.5°), the mean retroversion angle was 11.9° ± 5.4° (95% CI 9.8°-14.1°) with a mean percent error with respect to 15° of -21% ± 36 (95% CI -6 to -35). In the female subgroup (n = 27, range 0.9°-22.8°), mean retroversion angle was 8.0° ± 5.5° (95% CI 5.8°-10.1°) and the mean percent error with respect to 15° was -47% ± 36 (95% CI -32 to -61). The differences between the 2 gender groups were statistically significant (P = .006). CONCLUSION Referencing the forearm using an extramedullary forearm referencing system to position the humeral stem in a desired retroversion is neither accurate nor precise. There is a nonnegligible tendency to achieve a lower retroversion than planned, and the error is more marked in females.
Collapse
Affiliation(s)
- Mohammad N Jomaa
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia.
| | - Marco Branni
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Helen Ingoe
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Roberto Pareyon
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Marine Launay
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Asma Salhi
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Luke Gilliand
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - James Nielsen
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| | - Jashint Maharaj
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; St Andrews War Memorial Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Australian Shoulder Research Institute, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia; Akunah, Brisbane, QLD, Australia
| |
Collapse
|
4
|
Longo UG, Franceschetti E, Carnevale A, Schena E, Cozza G, Perricone G, Cardinale ME, Papalia R. Influence of Lateralization and Distalization on Joint Function after Primary Reverse Total Shoulder Arthroplasty. Bioengineering (Basel) 2023; 10:1409. [PMID: 38136000 PMCID: PMC10740542 DOI: 10.3390/bioengineering10121409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of this study was to investigate how lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) are related to clinical and kinematic outcomes after reverse total shoulder arthroplasty. Thirty-three patients were evaluated at least six months postoperatively. The Single Assessment Numeric Evaluation (SANE), Constant Murley Score (CMS), Simple Shoulder Test (SST), and Visual Analogue Scale (VAS) were used. Shoulder kinematics was evaluated with a stereophotogrammetric system. LSA and DSA inter-rater reliability was analysed through the interclass correlation coefficient (ICC). Stepwise forward linear regression analysis was conducted between LSA and DSA with clinical scales and kinematic measures, between which a correlation analysis was conducted. The inter-rater reliability for LSA (mean ICC = 0.93) and DSA (mean ICC = 0.97) results were good to excellent. Greater LSA values were associated with higher peaks of internal rotation (p = 0.012, R2 = 0.188) and range of motion (ROM) (p = 0.037, R2 = 0.133). SANE (p = 0.009), CMS (p = 0.031), and SST (0.026) were positively correlated to external rotation, while VAS (p = 0.020) was negatively related. Abduction peaks were positively related to CMS (p = 0.011) and SANE (p = 0.037), as well as abduction ROM (SANE, p = 0.031; CMS, p = 0.014).
Collapse
Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Arianna Carnevale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Emiliano Schena
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Laboratory of Measurement and Biomedical Instrumentation, Department of Engineering, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Giulia Cozza
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
| | - Giovanni Perricone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Marco Edoardo Cardinale
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Álvaro del Portillo, 200, 00128 Rome, Italy; (E.F.); (A.C.); (E.S.); (G.C.); (G.P.); (M.E.C.); (R.P.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| |
Collapse
|