International Orthopaedics

, Volume 43, Issue 3, pp 659–667 | Cite as

Assessment of anatomical and reverse total shoulder arthroplasty with the scapula-weighted Constant-Murley score

  • Giovanni MerollaEmail author
  • Ilaria Parel
  • Andrea Giovanni Cutti
  • Maria Vittoria Filippi
  • Paolo Paladini
  • Giuseppe Porcellini
Original Paper


Aim of the study

To evaluate total (TSA) and reverse total shoulder arthroplasty (RTSA) using the Constant-Murley score (CMS) and the scapula-weighted (SW) CMS, an integrated outcome measure that takes into account the compensatory movements of the scapula.


Twenty-five consecutive patients, 12 with TSA and 13 with RTSA, underwent kinematic analysis before and after shoulder replacement. Measurements included flexion (FLEX) and abduction (ABD) for the humerus and Protraction-Retraction (PR-RE), Medio-Lateral rotation (ME-LA), and Posterior-Anterior tilting (P-A) for the scapula. They were recorded at baseline (T0) and at six (T1) and 12 months (T2). Reference data were obtained from 31 control shoulders.


At T1, differences in CMS and SW-CMS were not significant in either group, whereas values at T2 were significantly lower in RTSA patients (p = 0.310 and p = 0.327, respectively). In TSA shoulders, the compensatory scapular movements in FLEX were all reduced from T0 to T2, whereas P-A was increased in ABD. In RTSA patients, the compensatory scapular movements in FLEX showed a general reduction at T1, with an increase in P-A at T2, whereas in ABD, all increased at T1 and decreased at T2 except for P-A, which did not decrease.


The SW-CMS showed that the physiological scapulothoracic motion was not restored in TSA and RTSA patients; it may be used as a reference for the gradual progression of deltoid and scapular muscle rehabilitation.


The worse CMS and SW-CMS scores found in RTSA patients at six months may be due to the biomechanics of the reverse prosthesis and to the weakness of deltoid and periscapular muscles.


Shoulder osteoarthritis Total arthroplasty Reverse Kinematic analysis Constant-Murley score Scapular dyskines 


Compliance with ethical standards

IRB approval was obtained from the institutional review board of the Coordinator Center in Cattolica, Italy (Prot. No. 5494/2012 I.5/197 CEAV/IRST Meldola, Italy).


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Giovanni Merolla
    • 1
    • 2
    Email author
  • Ilaria Parel
    • 2
  • Andrea Giovanni Cutti
    • 3
  • Maria Vittoria Filippi
    • 4
  • Paolo Paladini
    • 1
  • Giuseppe Porcellini
    • 5
  1. 1.Shoulder and Elbow UnitD. Cervesi HospitalCattolicaItaly
  2. 2.“Marco Simoncelli” Biomechanics LaboratoryD. Cervesi Hospital, Cattolica, AUSL della RomagnaAmbito RiminiItaly
  3. 3.INAIL Prostheses CenterVigorso di BudrioItaly
  4. 4.Functional Recovery and Rehabilitation Unit, AUSL della RomagnaAmbito RiminiItaly
  5. 5.Orthopaedic and Trauma Unit, Policlinico di ModenaUniversity of Modena and Reggio EmiliaModenaItaly

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