Reverse Total Shoulder Arthroplasty: Clinical Updates and Perspectives, Opportunities and Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 December 2022) | Viewed by 34214

Special Issue Editor


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Guest Editor
Department of Orthopaedic Surgery, University of Zurich, Uniklinik Balgrist, 8006 Zurich, Switzerland
Interests: orthopaedic trauma; upper limb trauma; proximal humerus fracture; shoulder arthroplasty; ORIF; upper limb biomechanics
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Special Issue Information

Dear Colleagues,

With the increasing success of reverse total shoulder arthroplasty (RTSA) over the past decade, the indications for RTSA have expanded from cuff tear arthropathy to other pathologies such as proximal humeral fracture sequelae or eccentric glenohumeral osteoarthritis. Several factors are associated with the increase in use of RTSA including novel implant designs, preoperative planning tools, surgeons’ experience and first studies on long-term results, as well as an increasingly aging population. With this boom of RTSA, the number of failures and revision surgeries will also continue to rise just as RTSA-specific complications including acromial fractures, tuberosity mal-/non-union, glenoid bone loss or instability. As a surgeon in the field of shoulder arthroplasty, it is therefore of tremendous importance to understand the biomechanics and design of available implants and configurations, know the implant specific complications associated with RTSA, and have salvage options in the situation of RTSA failure included in one’s surgical repertory. The aim of this special issue is to review the literature on indication and implant specific outcome, discuss and provide evidence for the potential benefits of preoperative planning tools, to shed light on unsolved problems in RTSA, and to provide a prospect in the field of RTSA.

Dr. Lukas Ernstbrunner
Guest Editor

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Keywords

  • reverse total shoulder arthroplasty
  • cuff tear arthropathy
  • osteoarthritis
  • proximal humeral fracture sequelae
  • revision
  • long-term outcome
  • implant design
  • biomechanics

Published Papers (14 papers)

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Editorial

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4 pages, 222 KiB  
Editorial
The Evolution of Reverse Total Shoulder Arthroplasty—Where Do We Stand and What Comes Next?
by Stefan Bauer and Lukas Ernstbrunner
J. Clin. Med. 2023, 12(5), 1945; https://doi.org/10.3390/jcm12051945 - 01 Mar 2023
Viewed by 1071
Abstract
Over 35 years ago, the pioneer Paul Grammont from Lyon published his ideas of a reversed semi-constraint prosthesis improving the moment arm of the deltoid by medializing the center of rotation and lengthening of the arm and thus increasing deltoid muscle tension [...] [...] Read more.
Over 35 years ago, the pioneer Paul Grammont from Lyon published his ideas of a reversed semi-constraint prosthesis improving the moment arm of the deltoid by medializing the center of rotation and lengthening of the arm and thus increasing deltoid muscle tension [...] Full article

Research

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9 pages, 950 KiB  
Article
Can We Completely Trust in Automated Software for Preoperative Planning of Shoulder Arthroplasty? Software Update May Modify Glenoid Version, Glenoid Inclination and Humeral Head Subluxation Values
by Raffaele Garofalo, Alberto Fontanarosa, Alessandro Castagna, Nunzio Lassandro, Angelo Del Buono and Angelo De Crescenzo
J. Clin. Med. 2023, 12(7), 2620; https://doi.org/10.3390/jcm12072620 - 30 Mar 2023
Viewed by 980
Abstract
Background: The purpose of this study was to evaluate the impact of software updating on measurements of the glenoid inclination and version, along with humeral head subluxation performed by an automated 3D planning program. The hypothesis was that the software update could significantly [...] Read more.
Background: The purpose of this study was to evaluate the impact of software updating on measurements of the glenoid inclination and version, along with humeral head subluxation performed by an automated 3D planning program. The hypothesis was that the software update could significantly modify the values of the glenoid inclination and version, as well as of the humeral head subluxation. Methods: A comprehensive pool of 76 shoulder computed tomography (CT) scans of patients who underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA) were analyzed with the automated program Blueprint in 2018 and again in 2020 after a software update. Results: A statistically significant difference of 8.1 ± 8.2 and 5.4 ± 7.8 (mean difference of −2.8 ± 5.0, p < 0.001) was indeed reached when comparing the mean glenoid inclination achieved with Blueprint 2018 and Blueprint 2020, respectively. The glenoid version, as well as the humeral head subluxation evaluations, were not significantly different between the two software versions, with mean values being −9.4 ± 8.9 and −9.0 ± 7.4 and 60.1 ± 12.6 and 61.8 ± 12.0, respectively (p = 0.708 and p = 0.115, respectively). In 22% of CT scans, the software update determined a variation of the glenoid inclination of more than 5° or 10°. Conclusion: The present study shows the software update of an automated preoperative planning program may significantly modify the values of glenoid inclination. Even though without a significant difference, variations were also found for the glenoid version and humeral head subluxation. Accordingly, these results should further advise surgeons to carefully and critically evaluate data acquired with automated software. Full article
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11 pages, 1758 KiB  
Article
Glenoid Inclination: Choosing the Transverse Axis Is Critical—A 3D Automated versus Manually Measured Study
by Marc-Olivier Gauci, Adrien Jacquot, François Boux de Casson, Pierric Deransart, Hoël Letissier and Julien Berhouet
J. Clin. Med. 2022, 11(20), 6050; https://doi.org/10.3390/jcm11206050 - 13 Oct 2022
Cited by 2 | Viewed by 2396
Abstract
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. [...] Read more.
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. Full article
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11 pages, 1379 KiB  
Article
Survivorship of Reverse Shoulder Arthroplasty According to Indication, Age and Gender
by Mikaël Chelli, Pascal Boileau, Peter Domos, Philippe Clavert, Julien Berhouet, Philippe Collin, Gilles Walch and Luc Favard
J. Clin. Med. 2022, 11(10), 2677; https://doi.org/10.3390/jcm11102677 - 10 May 2022
Cited by 16 | Viewed by 1767
Abstract
Background. The indications for reverse shoulder arthroplasty (RSA) have been widely expanded, but only a few studies report the long-term survival of these implants. Our objective was to report the long-term survivorship of a large series of RSAs implanted for different etiologies. Methods. [...] Read more.
Background. The indications for reverse shoulder arthroplasty (RSA) have been widely expanded, but only a few studies report the long-term survival of these implants. Our objective was to report the long-term survivorship of a large series of RSAs implanted for different etiologies. Methods. A retrospective multicenter study including all the RSAs was performed in six shoulder-specialized centers with at least 2 years of follow up. We reviewed 1611 RSAs, operated between 1993 and 2010, including 497 cuff-tear arthropathies (CTA), 239 revision RSAs, 188 massive cuff tears (MCT), 185 fracture sequelae (FS), 183 failed previous cuff repairs (FCR), and 142 primary osteoarthritis (POA). The mean follow-up was 5.6 ± 3.9 years (range 2–20). Results. Overall, 266 RSAs (16.5%) had at least one complication leading to 64 reoperations (4.0%) and 110 revision surgeries (6.8%). The most frequent complications were infection (3.8%), instability (2.8%), and humerus-related complications (2.8%). At 10 years, the survival without revision surgery was 91.0% in primary RSAs and 80.9% in revision RSAs for failed arthroplasty (p < 0.001). In the primary RSA group, MCT and FCR led to 10-year survivals for over 95% but fracture sequelae and tumors had the lowest 10-year survivals (83.9% and 53.1%). Younger patients had a lower 10-year survival. In revision RSAs, male patients had a significantly lower survival than females (72.3% vs. 84.5% at 10 years, p = 0.020). Discussion. Primary RSA for cuff-deficient shoulders or POA leads to a high 10-year survival, but revision RSA or primary RSA for FS and tumors are at high-risk for revision. Surgeons should be aware of high rates of complications and lower survival rates of RSA in younger patients, in males, and in RSAs for revision surgery. Full article
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9 pages, 3087 KiB  
Article
Functional and Radiological Outcomes after Treatment with Custom-Made Glenoid Components in Revision Reverse Shoulder Arthroplasty
by Reinhold Ortmaier, Guido Wierer and Michael Stephan Gruber
J. Clin. Med. 2022, 11(3), 551; https://doi.org/10.3390/jcm11030551 - 22 Jan 2022
Cited by 9 | Viewed by 2792
Abstract
Glenoid implant position and fixation are challenging in severe glenoid defects in reverse total shoulder arthroplasty (rTSA). Custom-made glenoid implants are metal augmented implants that are specially produced for a certain defect. They provide the restoration of the joint line and proper fixation. [...] Read more.
Glenoid implant position and fixation are challenging in severe glenoid defects in reverse total shoulder arthroplasty (rTSA). Custom-made glenoid implants are metal augmented implants that are specially produced for a certain defect. They provide the restoration of the joint line and proper fixation. This retrospective data analysis investigated the clinical and radiological outcomes after revision using custom-made glenoid implants. Between 2018 and 2020, nine patients (10 shoulders) with severe glenoid defects underwent revision rTSA using a custom-made glenoid implant (Materialise Glenius or Lima ProMade). The pre- and postoperative Constant Murley Score (CMS), UCLA Score and Subjective Shoulder Value (SSV) were assessed. Postoperative CT scans and X-rays in two planes were available. The minimum follow-up was 12 months, with a mean follow-up of 23.1 months. The mean preoperative CMS, UCLA Score and SSV were 10.9, 4.1 and 11.0, respectively. The mean postoperative CMS, UCLA Score and SSV showed significant increases of 51.7 (<0.001), 22.9 (<0.001) and 52.0 (<0.001), respectively. There were no signs of loosening implants or scapular notching, and no revision was necessary. This trial showed promising clinical and radiological short-term outcomes for custom-made glenoid components in revision rTSA. Full article
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8 pages, 824 KiB  
Article
Defining a Synovial Fluid White Blood Cell Count Threshold to Predict Periprosthetic Infection after Shoulder Arthroplasty
by Laura Elisa Streck, Chiara Gaal, Johannes Forster, Christian Konrads, Sebastian Philipp von Hertzberg-Boelch and Kilian Rueckl
J. Clin. Med. 2022, 11(1), 50; https://doi.org/10.3390/jcm11010050 - 23 Dec 2021
Cited by 3 | Viewed by 2115
Abstract
Background: The diagnosis of periprosthetic shoulder infection (PSI) requires a thorough diagnostic workup. Synovial fluid aspiration has been proven to be a reliable tool in the diagnosis of joint infections of the lower extremity, but shoulder specific data is limited. This study defines [...] Read more.
Background: The diagnosis of periprosthetic shoulder infection (PSI) requires a thorough diagnostic workup. Synovial fluid aspiration has been proven to be a reliable tool in the diagnosis of joint infections of the lower extremity, but shoulder specific data is limited. This study defines a threshold for synovial fluid white blood cell count (WBC) and assesses the reliability of microbiological cultures. Methods: Retrospective study of preoperative and intraoperative fluid aspiration of 31 patients who underwent a revision of a shoulder arthroplasty (15 with PSI defined by IDSA criteria, 16 without infection). The threshold for WBC was calculated by ROC/AUC analysis. Results: WBC was significantly higher in patients with PSI than in other patients. A threshold of 2800 leucocytes/mm3 showed a sensitivity of 87% and a specificity of 88% (AUROC 0.92). Microbiological cultures showed a sensitivity of 76% and a specificity of 100%. Conclusions: A threshold of 2800 leucocytes/mm3 in synovial fluid can be recommended to predict PSI. Microbiological culture has an excellent specificity and allows for targeted antibiotic therapy. Joint aspiration presents an important pillar to diagnose PSI. Full article
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Review

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11 pages, 1550 KiB  
Review
Challenges for Optimization of Reverse Shoulder Arthroplasty Part I: External Rotation, Extension and Internal Rotation
by Stefan Bauer, William G. Blakeney, Allan W. Wang, Lukas Ernstbrunner, Jean-David Werthel and Jocelyn Corbaz
J. Clin. Med. 2023, 12(5), 1814; https://doi.org/10.3390/jcm12051814 - 24 Feb 2023
Cited by 3 | Viewed by 1696
Abstract
A detailed overview of the basic science and clinical literature reporting on the challenges for the optimization of reverse shoulder arthroplasty (RSA) is presented in two review articles. Part I looks at (I) external rotation and extension, (II) internal rotation and the analysis [...] Read more.
A detailed overview of the basic science and clinical literature reporting on the challenges for the optimization of reverse shoulder arthroplasty (RSA) is presented in two review articles. Part I looks at (I) external rotation and extension, (II) internal rotation and the analysis and discussion of the interplay of different factors influencing these challenges. In part II, we focus on (III) the conservation of sufficient subacromial and coracohumeral space, (IV) scapular posture and (V) moment arms and muscle tensioning. There is a need to define the criteria and algorithms for planning and execution of optimized, balanced RSA to improve the range of motion, function and longevity whilst minimizing complications. For an optimized RSA with the highest function, it is important not to overlook any of these challenges. This summary may be used as an aide memoire for RSA planning. Full article
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12 pages, 3152 KiB  
Review
Challenges for Optimization of Reverse Shoulder Arthroplasty Part II: Subacromial Space, Scapular Posture, Moment Arms and Muscle Tensioning
by Stefan Bauer, William G. Blakeney, Allan W. Wang, Lukas Ernstbrunner, Jocelyn Corbaz and Jean-David Werthel
J. Clin. Med. 2023, 12(4), 1616; https://doi.org/10.3390/jcm12041616 - 17 Feb 2023
Cited by 4 | Viewed by 2703 | Correction
Abstract
In part II of this comprehensive review on the optimization of reverse shoulder arthroplasty (RSA), we focus on three other challenges: 1. “Conservation of sufficient subacromial and coracohumeral space”; 2. “Scapular posture”; and 3. “Moment arms and muscle tensioning”. This paper follows a [...] Read more.
In part II of this comprehensive review on the optimization of reverse shoulder arthroplasty (RSA), we focus on three other challenges: 1. “Conservation of sufficient subacromial and coracohumeral space”; 2. “Scapular posture”; and 3. “Moment arms and muscle tensioning”. This paper follows a detailed review of the basic science and clinical literature of the challenges in part I: 1. “External rotation and extension” and 2. “Internal rotation”. “Conservation of sufficient subacromial and coracohumeral space” and “Scapular posture” may have a significant impact on the passive and active function of RSA. Understanding the implications of “Moment arms and muscle tensioning” is essential to optimize active force generation and RSA performance. An awareness and understanding of the challenges of the optimization of RSA help surgeons prevent complications and improve RSA function and raise further research questions for ongoing study. Full article
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15 pages, 1121 KiB  
Review
The Evolution of Reverse Total Shoulder Arthroplasty—From the First Steps to Novel Implant Designs and Surgical Techniques
by Julia K. Frank, Paul Siegert, Fabian Plachel, Philipp R. Heuberer, Stephanie Huber and Jakob E. Schanda
J. Clin. Med. 2022, 11(6), 1512; https://doi.org/10.3390/jcm11061512 - 10 Mar 2022
Cited by 10 | Viewed by 4916
Abstract
Purpose of Review: The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. Recent findings: Over the past decade, worldwide implantation rates of reverse [...] Read more.
Purpose of Review: The purpose of this review is to summarize recent literature regarding the latest design modifications and biomechanical evolutions of reverse total shoulder arthroplasty and their impact on postoperative outcomes. Recent findings: Over the past decade, worldwide implantation rates of reverse total shoulder arthroplasty have drastically increased for various shoulder pathologies. While Paul Grammont’s design principles first published in 1985 for reverse total shoulder arthroplasty remained unchanged, several adjustments were made to address postoperative clinical and biomechanical challenges such as implant glenoid loosening, scapular notching, or limited range of motion in order to maximize functional outcomes and increase the longevity of reverse total shoulder arthroplasty. However, the adequate and stable fixation of prosthetic components can be challenging, especially in massive osteoarthritis with concomitant bone loss. To overcome such issues, surgical navigation and patient-specific instruments may be a viable tool to improve accurate prosthetic component positioning. Nevertheless, larger clinical series on the accuracy and possible complications of this novel technique are still missing. Full article
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14 pages, 2030 KiB  
Review
Factors Influencing Acromial and Scapular Spine Strain after Reverse Total Shoulder Arthroplasty: A Systematic Review of Biomechanical Studies
by Alexander Paszicsnyek, Olivia Jo, Harshi Sandeepa Rupasinghe, David C. Ackland, Thomas Treseder, Christopher Pullen, Greg Hoy, Eugene T. Ek and Lukas Ernstbrunner
J. Clin. Med. 2022, 11(2), 361; https://doi.org/10.3390/jcm11020361 - 12 Jan 2022
Cited by 10 | Viewed by 2191
Abstract
Background: Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments. The purpose of this study was to review factors associated with increased acromial and scapular spine strain after RTSA from a biomechanical [...] Read more.
Background: Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) can be devastating complications leading to substantial functional impairments. The purpose of this study was to review factors associated with increased acromial and scapular spine strain after RTSA from a biomechanical standpoint. Methods: A systematic review of the literature was conducted based on PRISMA guidelines. PubMed, Embase, OVID Medline, and CENTRAL databases were searched and strict inclusion and exclusion criteria were applied. Each article was assessed using the modified Downs and Black checklist to appraise the quality of included studies. Study selection, extraction of data, and assessment of methodological quality were carried out independently by two of the authors. Only biomechanical studies were considered. Results: Six biomechanical studies evaluated factors associated with increased acromial and scapular spine strain and stress. Significant increases in acromial and scapular spine strain were found with increasing lateralization of the glenosphere in four of the included studies. In two studies, glenosphere inferiorization consistently reduced acromial strain. The results concerning humeral lateralization were variable between four studies. Humeral component neck-shaft angle had no significant effect on acromial strain as analysed in one study. One study showed that scapular spine strain was significantly increased with a more posteriorly oriented acromion (55° vs. 43°; p < 0.001). Another study showed that the transection of the coracoacromial ligament increased scapular spine strain in all abduction angles (p < 0.05). Conclusions: Glenoid lateralization was consistently associated with increased acromial and scapular spine strain, whereas inferiorization of the glenosphere reduced strain in the biomechanical studies analysed in this systematic review. Humeral-sided lateralization may increase or decrease acromial or scapular spine strain. Independent of different design parameters, the transection of the coracoacromial ligament resulted in significantly increased strains and scapular spine strains were also increased when the acromion was more posteriorly oriented. The results found in this systematic review of biomechanical in-silico and in-vitro studies may help in the surgical planning of RTSA to mitigate complications associated with acromion and scapular spine fracture. Full article
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12 pages, 651 KiB  
Review
Does Humeral Component Version Affect Range of Motion and Clinical Outcomes in Reverse Total Shoulder Arthroplasty? A Systematic Review
by Shivan S. Jassim, Lukas Ernstbrunner and Eugene T. Ek
J. Clin. Med. 2021, 10(24), 5745; https://doi.org/10.3390/jcm10245745 - 08 Dec 2021
Cited by 7 | Viewed by 2572
Abstract
Background: Prosthesis selection, design, and placement in reverse total shoulder arthroplasty (RTSA) affect post-operative results. The aim of this systematic review was to evaluate the influence of the humeral stem version and prosthesis design (inlay vs. onlay) on shoulder function following RTSA. Methods: [...] Read more.
Background: Prosthesis selection, design, and placement in reverse total shoulder arthroplasty (RTSA) affect post-operative results. The aim of this systematic review was to evaluate the influence of the humeral stem version and prosthesis design (inlay vs. onlay) on shoulder function following RTSA. Methods: A systematic review of the literature on post-operative range of motion (ROM) and functional scores following RTSA with specifically known humeral stem implantations was performed using MEDLINE, Pubmed, and Embase databases, and the Cochrane Library. Functional scores included were Constant scores (CSs) and/or American Shoulder and Elbow Surgeons (ASES) scores. The patients were organised into three separate groups based on the implanted version of their humeral stem: (1) less than 20° of retroversion, (2) 20° of retroversion, and (3) greater than 20° of retroversion. Results: Data from 14 studies and a total of 1221 shoulders were eligible for analysis. Patients with a humeral stem implanted at 20° of retroversion had similar post-operative mean ASES (75.8 points) and absolute CS (68.1 points) compared to the group with humeral stems implanted at less than 20° of retroversion (76 points and 62.5 points; p = 0.956 and p = 0.153) and those implanted at more than 20° of retroversion (73.3 points; p = 0.682). Subjects with humeral stem retroversion at greater than 20° tended towards greater active forward elevation and external rotation compared with the group at 20° of retroversion (p = 0.462) and those with less than 20° of retroversion (p = 0.192). Patients with an onlay-type RTSA showed statistically significantly higher mean post-operative internal rotation compared to patients with inlay-type RTSA designs (p = 0.048). Other functional scores and forward elevation results favoured the onlay-types, but greater external rotation was seen in inlay-type RTSA designs (p = 0.382). Conclusions: Humeral stem implantation in RTSA at 20° of retroversion and greater appears to be associated with higher post-operative outcome scores and a greater range of motion when compared with a retroversion of less than 20°. Within these studies, onlay-type RTSA designs were associated with greater forward elevation but less external rotation when compared to inlay-type designs. However, none of the differences in outcome scores and range of motion between the humeral version groups were statistically significant. Full article
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14 pages, 4295 KiB  
Review
Lateralization in Reverse Shoulder Arthroplasty
by Stefan Bauer, Jocelyn Corbaz, George S. Athwal, Gilles Walch and William G. Blakeney
J. Clin. Med. 2021, 10(22), 5380; https://doi.org/10.3390/jcm10225380 - 18 Nov 2021
Cited by 17 | Viewed by 3806
Abstract
Indications for Reverse Shoulder Arthroplasty (RSA) have been extended over the last 25 years, and RSA has become the most frequently implanted shoulder arthroplasty worldwide. The initial Grammont design with medialization of the joint center of rotation (JCOR), placement of the JCOR at [...] Read more.
Indications for Reverse Shoulder Arthroplasty (RSA) have been extended over the last 25 years, and RSA has become the most frequently implanted shoulder arthroplasty worldwide. The initial Grammont design with medialization of the joint center of rotation (JCOR), placement of the JCOR at the bone–implant interface, distalization and semi-constrained configuration has been associated with drawbacks such as reduced rotation and range of motion (ROM), notching, instability and loss of shoulder contour. This review summarizes new strategies to overcome these drawbacks and analyzes the use of glenoid-sided, humeral-sided or global bipolar lateralization, which are applied differently by surgeons and current implant manufacturers. Advantages and drawbacks are discussed. There is evidence that lateralization addresses the initial drawbacks of the Grammont design, improving stability, rates of notching, ROM and shoulder contour, but the ideal extent of lateralization of the glenoid and humerus remains unclear, as well as the maximal acceptable joint reaction force after reduction. Overstuffing and spine of scapula fractures are potential risks. CT-based 3D planning as well as artificial intelligence will help surgeons with planning and execution of appropriate lateralization in RSA. Long-term follow-up of lateralization with new implant designs and implantation strategies is needed. Full article
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15 pages, 2797 KiB  
Review
Complications of Reverse Total Shoulder Arthroplasty: A Computational Modelling Perspective
by Yichen Huang, Lukas Ernstbrunner, Dale L. Robinson, Peter Vee Sin Lee and David C. Ackland
J. Clin. Med. 2021, 10(22), 5336; https://doi.org/10.3390/jcm10225336 - 16 Nov 2021
Cited by 6 | Viewed by 2881
Abstract
Reverse total shoulder arthroplasty (RTSA) is an established treatment for elderly patients with irreparable rotator cuff tears, complex proximal humerus fractures, and revision arthroplasty; however, with the increasing indications for RTSA over the last decade and younger implant recipients, post-operative complications have become [...] Read more.
Reverse total shoulder arthroplasty (RTSA) is an established treatment for elderly patients with irreparable rotator cuff tears, complex proximal humerus fractures, and revision arthroplasty; however, with the increasing indications for RTSA over the last decade and younger implant recipients, post-operative complications have become more frequent, which has driven advances in computational modeling and simulation of reverse shoulder biomechanics. The objective of this study was to provide a review of previously published studies that employed computational modeling to investigate complications associated with RTSA. Models and applications were reviewed and categorized into four possible complications that included scapular notching, component loosening, glenohumeral joint instability, and acromial and scapular spine fracture, all of which remain a common cause of significant functional impairment and revision surgery. The computational shoulder modeling studies reviewed were primarily used to investigate the effects of implant design, intraoperative component placement, and surgical technique on postoperative shoulder biomechanics after RTSA, with the findings ultimately used to elucidate and mitigate complications. The most significant challenge associated with the development of computational models is in the encapsulation of patient-specific anatomy and surgical planning. The findings of this review provide a basis for future direction in computational modeling of the reverse shoulder. Full article
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Other

8 pages, 468 KiB  
Systematic Review
Clinical and Radiological Outcomes after Total Shoulder Arthroplasty Using Custom-Made Glenoid Components: A Systematic Review
by Michael Stephan Gruber, Tamara Schwarz, Marlene Lindorfer, Felix Rittenschober, Martin Bischofreiter, Josef Hochreiter and Reinhold Ortmaier
J. Clin. Med. 2022, 11(24), 7268; https://doi.org/10.3390/jcm11247268 - 07 Dec 2022
Cited by 1 | Viewed by 931
Abstract
Reverse total shoulder arthroplasty presents itself sometimes as challenging when it comes to addressing massive bone loss, either in primary or revision settings. Custom components recently have made their way into shoulder prosthetics and are meant to help in the case of extensive [...] Read more.
Reverse total shoulder arthroplasty presents itself sometimes as challenging when it comes to addressing massive bone loss, either in primary or revision settings. Custom components recently have made their way into shoulder prosthetics and are meant to help in the case of extensive glenoid bone destruction. Because of strict indication and the fairly recent introduction of these implants, the usage of custom-made glenoid implants is not very common yet. However, the early results are promising. The purpose of this review was to summarize and analyze the available literature. Therefore, a systematic review was performed according to PRISMA guidelines. A comprehensive search of the databases PubMed, Cochrane, and Livivo was performed to screen for studies reporting on clinical and radiological outcomes of custom glenoid implants. Four studies with a total of 46 shoulders were included in this review. The mean patient age was 68.8 years and the mean time of follow-up was 24.3 months. The weighted means showed an increase in CMS (32.7 points), in ASES (39.8 points), in anteversion (67.4 degrees), and in abduction (51.9 degrees) and a decrease in VAS (5.4 points). Custom-made glenoid implants are therefore a viable option in cases of large combined glenoid bone loss, both in primary and revision shoulder arthroplasty. Full article
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