Preoperative deltoid assessment by contrast-enhanced ultrasound (CEUS) as predictor for shoulder function after reverse shoulder arthroplasty: a prospective pilot study
- 43 Downloads
Although the deltoid represents the main motor muscle after reverse shoulder arthroplasty (RSA), its standardized preoperative assessment regarding morphology and function is still not established. Its clinical relevance and interactions with major biomechanical parameters like the medialization of the center of rotation (COR) regarding shoulder function after RSA are yet unknown. We evaluated contrast-enhanced ultrasound (CEUS) of the deltoid as possible surrogate marker for individual deltoid properties of patients receiving an RSA, and its predictive value for postoperative shoulder function.
Materials and methods
35 patients were prospectively assessed. Before and 6 months after RSA, dynamic deltoid perfusion, caliber and a combination of both (PE*caliber, named DeltoidEfficacy) was quantified by CEUS. Changes of deltoid properties and the predictive value of preoperative CEUS-based deltoid properties for shoulder function after RSA were assessed. To analyze interrelating effects with deltoid properties, COR-medialization and deltoid lengthening were quantified.
Deltoid caliber and perfusion significantly increased after RSA (p = 0.0004/p = 0.002). Preoperative deltoid caliber, perfusion and the combined value DeltoidEfficacy significantly correlated with shoulder function after RSA within the whole study cohort (caliber: r = 0.445, p = 0.009; perfusion: r = 0.593, p = 0.001; DeltoidEfficacy: r = 0.66; p = 0.0002). The predictive value of DeltoidEfficacy for shoulder function after RSA varied among patient subgroups: Multivariate regression analysis revealed the strongest prediction in patients with either very high or very low deltoid properties (Beta = 0.872, r = 0.84, p = 0.0004), independent from COR-medialization or deltoid lengthening. Contrary, in patients with intermediate deltoid properties, COR-medialization revealed the strongest predictive value for shoulder function after RSA (Beta = 0.660, r = 0.597; p = 0.024).
Deltoid CEUS seems to allow an assessment of individual deltoid properties and deltoid adaptations after RSA. Deltoid CEUS seems to predict shoulder function after RSA and might support an identification of patients requiring special attention regarding COR positioning.
KeywordsCEUS RSA Predictor Deltoid assessment Center of rotation Reverse shoulder arthroplasty
We thank the German Society for Ultrasound in Medicine (DEGUM) for funding the study (Grant number 2015-05-27-A)
The study was funded by the German Society for Ultrasound in Medicine (DEGUM) (Grant number 2015–05-27-A).
Compliance with ethical standards
Conflict of interest
None of the authors, their immediate family, and any research foundation with which they are affiliated did receive any financial payments or other benefits from any commercial entity related to the subject of this article.
The prospective longitudinal cohort study was approved by the ethics committee of the University of Heidelberg (S626/2014) and registered at the German Clinical Trials Register (DRK S00010934).
- 3.Grammont PTP, Laffay J, Deries X (1987) Concept study and realization of a new total shoulder prosthesis. Rhumatologie 39:407–418Google Scholar
- 5.Giles JW, Langohr GD, Johnson JA, Athwal GS (2015) Implant design variations in reverse total shoulder arthroplasty influence the required deltoid force and resultant joint load. Clin Orthop Relat Res 473(11):3615–3626. https://doi.org/10.1007/s11999-015-4526-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Wiater BP, Koueiter DM, Maerz T, Moravek JE Jr, Yonan S, Marcantonio DR, Wiater JM (2015) Preoperative deltoid size and fatty infiltration of the deltoid and rotator cuff correlate to outcomes after reverse total shoulder arthroplasty. Clin Orthop Relat Res 473(2):663–673. https://doi.org/10.1007/s11999-014-4047-2 CrossRefPubMedGoogle Scholar
- 10.Yoon JP, Seo A, Kim JJ, Lee CH, Baek SH, Kim SY, Jeong ET, Oh KS, Chung SW (2017) Deltoid muscle volume affects clinical outcome of reverse total shoulder arthroplasty in patients with cuff tear arthropathy or irreparable cuff tears. PLoS ONE 12(3):e0174361. https://doi.org/10.1371/journal.pone.0174361 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Amarteifio E, Krix M, Wormsbecher S, Demirel S, Braun S, Delorme S, Kauczor HU, Bockler D, Weber MA (2013) Dynamic contrast-enhanced ultrasound for assessment of therapy effects on skeletal muscle microcirculation in peripheral arterial disease: pilot study. Eur J Radiol 82(4):640–646. https://doi.org/10.1016/j.ejrad.2012.11.022 CrossRefPubMedGoogle Scholar
- 12.Hildebrandt W, Schwarzbach H, Pardun A, Hannemann L, Bogs B, Konig AM, Mahnken AH, Hildebrandt O, Koehler U, Kinscherf R (2017) Age-related differences in skeletal muscle microvascular response to exercise as detected by contrast-enhanced ultrasound (CEUS). PLoS ONE 12(3):e0172771. https://doi.org/10.1371/journal.pone.0172771 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Thomas KN, Cotter JD, Lucas SJ, Hill BG, van Rij AM (2015) Reliability of contrast-enhanced ultrasound for the assessment of muscle perfusion in health and peripheral arterial disease. Ultrasound Med Biol 41(1):26–34. https://doi.org/10.1016/j.ultrasmedbio.2014.06.012 CrossRefPubMedGoogle Scholar
- 15.Weber MA, Krakowski-Roosen H, Hildebrandt W, Schroder L, Ionescu I, Krix M, Kinscherf R, Bachert P, Kauczor HU, Essig M (2007) Assessment of metabolism and microcirculation of healthy skeletal muscles by magnetic resonance and ultrasound techniques. J Neuroimaging 17(4):323–331. https://doi.org/10.1111/j.1552-6569.2007.00156.x CrossRefPubMedGoogle Scholar
- 17.Fischer C, Krammer D, Hug A, Weber MA, Kauczor HU, Krix M, Bruckner T, Kunz P, Schmidmaier G, Zeifang F (2017) Dynamic contrast-enhanced ultrasound and elastography assess deltoid muscle integrity after reverse shoulder arthroplasty. J Shoulder Elbow Surg 26(1):108–117. https://doi.org/10.1016/j.jse.2016.04.012 CrossRefPubMedGoogle Scholar
- 18.Fischer C, Gross S, Zeifang F, Schmidmaier G, Weber MA, Kunz P (2018) Contrast-enhanced ultrasound determines supraspinatus muscle atrophy after cuff repair and correlates to functional shoulder outcome. Am J Sports Med 46(11):2735–2742. https://doi.org/10.1177/0363546518787266 CrossRefPubMedGoogle Scholar
- 19.von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X CrossRefGoogle Scholar
- 21.Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC, Standards for Reporting of Diagnostic A (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Standards for Reporting of Diagnostic Accuracy. Clin Chem 49(1):1–6CrossRefPubMedGoogle Scholar
- 22.Dietrich CF, Averkiou M, Nielsen MB, Barr RG, Burns PN, Calliada F, Cantisani V, Choi B, Chammas MC, Clevert DA, Claudon M, Correas JM, Cui XW, Cosgrove D, D'Onofrio M, Dong Y, Eisenbrey J, Fontanilla T, Gilja OH, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lyshchik A, Franca Meloni M, Moriyasu F, Nolsoe C, Piscaglia F, Radzina M, Saftoiu A, Sidhu PS, Sporea I, Schreiber-Dietrich D, Sirlin CB, Stanczak M, Weskott HP, Wilson SR, Willmann JK, Kim TK, Jang HJ, Vezeridis A, Westerway S (2018) How to perform Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open 4(1):E2–e15. https://doi.org/10.1055/s-0043-123931 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Sidhu PS, Cantisani V, Dietrich CF, Gilja OH, Saftoiu A, Bartels E, Bertolotto M, Calliada F, Clevert DA, Cosgrove D, Deganello A, D'Onofrio M, Drudi FM, Freeman S, Harvey C, Jenssen C, Jung EM, Klauser AS, Lassau N, Meloni MF, Leen E, Nicolau C, Nolsoe C, Piscaglia F, Prada F, Prosch H, Radzina M, Savelli L, Weskott HP, Wijkstra H (2018) The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in non-hepatic applications: update 2017 (long version). Ultraschall Med. https://doi.org/10.1055/a-0586-1107 CrossRefPubMedGoogle Scholar
- 24.Jobin CM, Brown GD, Bahu MJ, Gardner TR, Bigliani LU, Levine WN, Ahmad CS (2012) Reverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization. J Shoulder Elbow Surg 21(10):1269–1277. https://doi.org/10.1016/j.jse.2011.08.049 CrossRefPubMedGoogle Scholar
- 27.Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15(5):527–540. https://doi.org/10.1016/j.jse.2006.01.003 CrossRefPubMedGoogle Scholar
- 31.Saltzman MD, Mercer DM, Warme WJ, Bertelsen AL, Matsen FA 3rd (2010) A method for documenting the change in center of rotation with reverse total shoulder arthroplasty and its application to a consecutive series of 68 shoulders having reconstruction with one of two different reverse prostheses. J Shoulder Elbow Surg 19(7):1028–1033. https://doi.org/10.1016/j.jse.2010.01.021 CrossRefPubMedGoogle Scholar
- 35.Rudzki JR, Adler RS, Warren RF, Kadrmas WR, Verma N, Pearle AD, Lyman S, Fealy S (2008) Contrast-enhanced ultrasound characterization of the vascularity of the rotator cuff tendon: age- and activity-related changes in the intact asymptomatic rotator cuff. J Shoulder Elbow Surg 17(1 Suppl):96s–100s. https://doi.org/10.1016/j.jse.2007.07.004 CrossRefPubMedGoogle Scholar