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Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty
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Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty

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

Deadline for manuscript submissions: 17 June 2024 | Viewed by 2507

Special Issue Editors

Dr. Stefan Bauer

E-Mail Website
Guest Editor
1. Service d’Orthopédie et de Traumatologie, Ensemble Hospitalier de la Côte, Morges, Switzerland
2. School of Surgery, University of Western Australia, Perth, Australia
Interests: shoulder arthroplasty; optimization of reverse shoulder arthroplasty; lateralization; 3D planning; shoulder instability; Latarjet; subscapularis repair; rotator cuff repair
Dr. Allan W. Wang

E-Mail Website
Guest Editor
School of Surgery, University of Western Australia, Perth, Australia
Interests: shoulder arthroplasty; optimization of reverse arthroplasty; shoulder arthroscopy; elbow and hand surgery
Dr. William G. Blakeney

E-Mail Website
Guest Editor
1. Associate Professor, Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
2. Department of Surgery, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
Interests: orthopaedic trauma; shoulder, hip and knee surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Jean-David Werthel

E-Mail Website
Guest Editor
Service d’Orthopédie et de Traumatologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France
Interests: optimization of reverse shoulder arthroplasty; soft tissue assessment and planning; shoulder instability; tendon transfers; shoulder arthroscopy

Special Issue Information

Dear Colleagues,

Reverse shoulder arthroplasty (RSA) has become the mainstay of shoulder arthroplasty in the 21st century and is considered the most important breakthrough and innovation in upper limb arthroplasty in the last 50 years.

Surgical planning for RSA is critical to achieving optimal implant positioning. Initially, basic templating used radiographs or 2D CT scans as a reference; this shifted to a patient-specific implantation (PSI) approach with the introduction of 3D software. More recently, CT-based navigation has also been developed, followed by the advent of mixed and augmented reality—bringing the surgical plan into the field of view of the operating surgeon. Surgery can be guided by augmented-reality-based navigation and optimized using robotic reaming and saw cuts. However, in times of limited resources and tight budgets, questions arise about whether these developments are cost-effective for clinical improvements, in terms of “time to return to activities of daily living” and long-term outcomes. Are these improvements measurable? Additionally, in which cases should we be using this technology?

Artificial intelligence (AI) has become more readily available and can help us find the best implant combination and position. AI can learn from the previous actions of experienced surgeons and deep learn “the best way” to implant for a given case.

In terms of planning rotator cuff tendon and deltoid tension, the integration of muscle volume and fatty infiltration and the integration of scapulothoracic posture, motion and kinematics, we are only in the early stages of an exciting field of research that has been overlooked for a long time due to a lack of valid assessment tools.

The biomechanics of RSA have shifted from Grammont’s design, with a medialized center of rotation and a long moment arm, to the modern lateralized RSA. Lateralized RSA can be performed in different ways, with lateralization of the glenoid, humerus or combined, and with different amounts of distalization, lengths of moment arms and neck shaft angles. Some developers speak of “biomechanical” RSA lateralization (longer moment arms) and “anatomic” RSA lateralization, with closer to normal muscle length with better contractility.

There are still many questions to be answered, and the fascinating journey of RSA lies ahead of us. The aim of this Special Issue is to provide an overview of the new “tools” available on the market and present advances in soft tissue and scapulothoracic integration, as well as biomechanics and clinical results.

We are looking forward to receiving your contributions to advance our understanding and knowledge in these fields.

Dr. Stefan Bauer
Dr. Allan W. Wang
Dr. William G. Blakeney
Dr. Jean-David Werthel
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

Published Papers (3 papers)

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Research

18 pages, 3405 KiB  
Article
The Use of Glenoid Structural Allografts for Glenoid Bone Defects in Reverse Shoulder Arthroplasty
by Helen Ingoe, Kristine Italia, Luke Gilliland, Hean Wu Kang, Mirek Karel, Jashint Maharaj, Kenneth Cutbush and Ashish Gupta
J. Clin. Med. 2024, 13(7), 2008; https://doi.org/10.3390/jcm13072008 - 29 Mar 2024
Viewed by 532
Abstract
Background: The use of reverse shoulder arthroplasty as a primary and revision implant is increasing. Advances in implant design and preoperative surgical planning allow the management of complex glenoid defects. As the demand for treating severe bone loss increases, custom allograft composites are [...] Read more.
Background: The use of reverse shoulder arthroplasty as a primary and revision implant is increasing. Advances in implant design and preoperative surgical planning allow the management of complex glenoid defects. As the demand for treating severe bone loss increases, custom allograft composites are needed to match the premorbid anatomy. Baseplate composite structural allografts are used in patients with eccentric and centric defects to restore the glenoid joint line. Preserving bone stock is important in younger patients where a revision surgery is expected. The aim of this article is to present the assessment, planning, and indications of femoral head allografting for bony defects of the glenoid. Methods: The preoperative surgical planning and the surgical technique to execute the plan with a baseplate composite graft are detailed. The preliminary clinical and radiological results of 29 shoulders which have undergone this graft planning and surgical technique are discussed. Clinical outcomes included visual analogue score of pain (VAS), American Shoulder and Elbow Surgeons score (ASES), Constant–Murley score (CS), satisfaction before and after operation, and active range of motion. Radiological outcomes included graft healing and presence of osteolysis or loosening. Results: The use of composite grafts in this series has shown excellent clinical outcomes, with an overall graft complication rate in complex bone loss cases of 8%. Conclusion: Femoral head structural allografting is a valid and viable surgical option for glenoid bone defects in reverse shoulder arthroplasty. Full article
(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)
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34 pages, 4150 KiB  
Article
Impact of Deltoid Computer Tomography Image Data on the Accuracy of Machine Learning Predictions of Clinical Outcomes after Anatomic and Reverse Total Shoulder Arthroplasty
by Hamidreza Rajabzadeh-Oghaz, Vikas Kumar, David B. Berry, Anshu Singh, Bradley S. Schoch, William R. Aibinder, Bruno Gobbato, Sandrine Polakovic, Josie Elwell and Christopher P. Roche
J. Clin. Med. 2024, 13(5), 1273; https://doi.org/10.3390/jcm13051273 - 23 Feb 2024
Viewed by 991
Abstract
Background: Despite the importance of the deltoid to shoulder biomechanics, very few studies have quantified the three-dimensional shape, size, or quality of the deltoid muscle, and no studies have correlated these measurements to clinical outcomes after anatomic (aTSA) and/or reverse (rTSA) total shoulder [...] Read more.
Background: Despite the importance of the deltoid to shoulder biomechanics, very few studies have quantified the three-dimensional shape, size, or quality of the deltoid muscle, and no studies have correlated these measurements to clinical outcomes after anatomic (aTSA) and/or reverse (rTSA) total shoulder arthroplasty in any statistically/scientifically relevant manner. Methods: Preoperative computer tomography (CT) images from 1057 patients (585 female, 469 male; 799 primary rTSA and 258 primary aTSA) of a single platform shoulder arthroplasty prosthesis (Equinoxe; Exactech, Inc., Gainesville, FL) were analyzed in this study. A machine learning (ML) framework was used to segment the deltoid muscle for 1057 patients and quantify 15 different muscle characteristics, including volumetric (size, shape, etc.) and intensity-based Hounsfield (HU) measurements. These deltoid measurements were correlated to postoperative clinical outcomes and utilized as inputs to train/test ML algorithms used to predict postoperative outcomes at multiple postoperative timepoints (1 year, 2–3 years, and 3–5 years) for aTSA and rTSA. Results: Numerous deltoid muscle measurements were demonstrated to significantly vary with age, gender, prosthesis type, and CT image kernel; notably, normalized deltoid volume and deltoid fatty infiltration were demonstrated to be relevant to preoperative and postoperative clinical outcomes after aTSA and rTSA. Incorporating deltoid image data into the ML models improved clinical outcome prediction accuracy relative to ML algorithms without image data, particularly for the prediction of abduction and forward elevation after aTSA and rTSA. Analyzing ML feature importance facilitated rank-ordering of the deltoid image measurements relevant to aTSA and rTSA clinical outcomes. Specifically, we identified that deltoid shape flatness, normalized deltoid volume, deltoid voxel skewness, and deltoid shape sphericity were the most predictive image-based features used to predict clinical outcomes after aTSA and rTSA. Many of these deltoid measurements were found to be more predictive of aTSA and rTSA postoperative outcomes than patient demographic data, comorbidity data, and diagnosis data. Conclusions: While future work is required to further refine the ML models, which include additional shoulder muscles, like the rotator cuff, our results show promise that the developed ML framework can be used to evolve traditional CT-based preoperative planning software into an evidence-based ML clinical decision support tool. Full article
(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)
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10 pages, 235 KiB  
Article
Two-Stage Exchange Arthroplasty for Periprosthetic Reverse Shoulder Arthroplasty Infection Provides Comparable Functional Outcomes to Primary Reverse Shoulder Arthroplasty
by Maristella Francesca Saccomanno, Alexandre Lädermann and Philippe Collin
J. Clin. Med. 2024, 13(3), 904; https://doi.org/10.3390/jcm13030904 - 04 Feb 2024
Viewed by 566
Abstract
This study aimed to compare functional outcomes after two-stage revision reverse shoulder arthroplasty (RSA) for periprosthetic joint infection (PJI) with the results of primary RSA. Patients affected by PJI and treated by means of two-stage revision RSA were 1:1 matched with a group [...] Read more.
This study aimed to compare functional outcomes after two-stage revision reverse shoulder arthroplasty (RSA) for periprosthetic joint infection (PJI) with the results of primary RSA. Patients affected by PJI and treated by means of two-stage revision RSA were 1:1 matched with a group of patients who were treated electively with RSA without developing any complications. Out of 1477 RSAs performed between 2009 and 2021, 16 patients developed a PJI. Each matched cohort comprised 16 patients (3 females, 13 males). The mean age was 69.13 ± 5.43 years old in the PJI group and 70.28 ± 5.04 (p = 0.543) in the matched cohort. The mean follow-up was 41.23 ± 26.9 months in the PJI group and 28.5 ± 20.2 (p = 0.142) in the matched group. Only one patient showed recurrent PJI five years after revision RSA. Comparison between the PJI patients and matched patients did not show any significant differences at the latest follow-up, nor for subjective shoulder value (SSV) (p = 0.101) or Constant score (p = 0.134). Two-stage exchange RSA for PJI allows for appropriate control of the disease and good functional outcomes. Comparison with an age- and sex-matched cohort of uninfected patients showed no significant differences, thus confirming the idea that revision surgeries may lead to satisfactory functional outcomes, as expected after primary surgery. Full article
(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

1. Title: The assessment of postoperative outcome following RSA: current measures and future directions
Authors: Peter Edwards; Jay Ebert; Allan Wang; William Blakeney; Stefan Bauer

2. Title: Current state of planning software for reverse shoulder arthroplasty - that comes next?

Authors: K. Friedrich (1); JD. Werthel (2); W. Balakeney (3); S. Bauer (4)
Affiliation: (1) Medical Writer, Basel, Switzerland (2) Hôpital Ambroise Paré, Boulogne-Billancourt, France. (3) Royal Perth Hospital, Perth 6000, Australia (4) Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
Abstract: To date, reverse total shoulder arthroplasty (RTSA) is the standard of care for rotator cuff tear arthropathy. First discovered in the 1980s, the indications of RTSA have expanded thanks to the increased surgeon experience and fewer complications. Implant loosening and glenoid component failure are among the most common complications of RTSA and strongly impact long-term outcomes. Despite the enormous advances in implant design and surgical techniques, surgeons with all experience levels continue to face difficulties in choosing the best implant for the specific patient and positioning it correctly to avoid complications. Various techniques (i.e., two- and three-dimensional preoperative planning software, intraoperative computer navigation, and patient-specific instrumentation) currently offer optimized implant selection and more precise positioning. However, patient-reported and clinical outcomes of appropriate implant selection and positioning remain unknown. Furthermore, a high methodological variability limits the accuracy and potential of these advanced technologies. This review provides a comprehensive overview of the evolution and state of the art of different preoperative planning technologies for RTSA, with a particular focus on selected 3D planning software solutions. This review discusses the advantages and limitations of the current technologies for RTSA planning and provides insights for future developments.

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