What is the best glenoid configuration in onlay reverse shoulder arthroplasty?
- 343 Downloads
The purpose of this study was to analyze the effect of different glenoid configurations on arm position and range of motion (ROM) following reverse shoulder arthroplasty (RSA). The hypothesis was that different glenoid configurations would lead to changes in humeral offset, acromio-humeral distance (AHD), ROM, and rotator cuff muscle length.
Using a three-dimensional (3D) computer model, implantation of an RSA was simulated with a 145° onlay humeral stem combined with five different glenoid configurations which varied in diameter and centre of rotation. Glenoid offset, the AHD, ROM, and muscle length were evaluated for each configuration.
Changing glenoid design led to up to a 10 mm change in offset and a 3 mm change in the AHD. There was 7° of improvement in abduction and flexion between the different glenoid designs. Two of the configurations, the 36 mm centered and the BIO-RSA, had an adduction deficit. In extension and external rotation arm with the arm at side, the eccentric 36 mm glenosphere was the best configuration while the centered 36 mm glenosphere was the worst configuration. The 42 mm glenosphere limited external rotation at 90° of abduction.
Varying the glenosphere configurations leads to ROM and muscle length changes following RSA. With a 145° onlay humeral stem, a 36 eccentric glenosphere theoretically optimizes ROM while limiting scapular notching.
KeywordsReverse total shoulder arthroplasty Onlay design Glenoid offset Arm position Complications Range of motion Muscle tension
Compliance with ethical standards
Conflicts of interest
Two authors (G.W., P.B.) of this study received royalties from the Wright Medical Group NV. One author (P.J.D.) is a paid consultant for Arthrex. One author (P.D.) of this study held stock from the Wright Medical Group NV.
- 3.Gutierrez S, Comiskey CA, Luo ZP, Pupello DR, Frankle MA (2008) Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am 90:2606–2615. https://doi.org/10.2106/JBJS.H.00012 CrossRefPubMedGoogle Scholar
- 4.Lädermann A, Gueorguiev B, Charbonnier C, Stimec BV, Fasel JH, Zderic I, Hagen J, Walch G (2015) Scapular notching on kinematic simulated range of motion after reverse shoulder arthroplasty is not the result of impingement in adduction. Medicine (Baltimore) 94:e1615. https://doi.org/10.1097/MD.0000000000001615 CrossRefGoogle Scholar
- 5.Berhouet J, Garaud P, Favard L (2013) Evaluation of the role of glenosphere design and humeral component retroversion in avoiding scapular notching during reverse shoulder arthroplasty. J Shoulder Elb Surg. https://doi.org/10.1016/j.jse.2013.05.009
- 6.Collin P, Liu X, Denard PJ, Gain S, Nowak A, Ladermann A (2017) Standard versus bony increased-offset reverse shoulder arthroplasty: a retrospective comparative cohort study. J Shoulder Elb Surg. https://doi.org/10.1016/j.jse.2017.07.020
- 12.Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D'Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I (2002) ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. International Society of Biomechanics J Biomech 35:543–548PubMedGoogle Scholar
- 25.Lädermann A, Denard PJ, Tirefort J, Collin P, Nowak A, Schwitzguebel AJ (2017) Subscapularis- and deltoid-sparing vs traditional deltopectoral approach in reverse shoulder arthroplasty: a prospective case–control study. J Orthop Surg Res 12:112. https://doi.org/10.1186/s13018-017-0617-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C (2013) Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: a radiological study of the critical shoulder angle. The Bone & Joint Journal 95-B:935–941. https://doi.org/10.1302/0301-620X.95B7.31028 CrossRefGoogle Scholar
- 28.Berhouet J, Garaud P, Slimane M, Nicot J, Banah J, Waynberger E, Favard L (2014) Effect of scapular pillar anatomy on scapular impingement in adduction and rotation after reverse shoulder arthroplasty. Orthopaedics & Traumatology, Surgery & Research: OTSR. https://doi.org/10.1016/j.otsr.2014.03.021