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: 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.
Highlights
The performance of reverse total shoulder replacement (RTSA) for several indications has been steadily increasing over a number of years [1,2,3,4,5,6,7,8]
There is a wide variation in practice as to the degrees of retroversion recreated, with biomechanical studies suggesting a compromise of avoiding scapular neck impingement by substituting a more anatomical version compared to increasing the range of motion, external rotation, by implanting the stem in progressive degrees of retroversion [12,13]
Our search strategy generated a total of 3572 studies, including those found from citation tracking
Summary
The performance of reverse total shoulder replacement (RTSA) for several indications has been steadily increasing over a number of years [1,2,3,4,5,6,7,8]. Since the advent of the Grammont-style prostheses in the 1980s [9], the evolution of RTSA implants has been well-documented, with respect to the glenoid component, with the progressive lateralisation and inferior shift of the glenosphere aiming to reduce scapula notching and component loosening while increasing range of motion (ROM) [10]. 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 known humeral stem implantations was performed using MEDLINE, Pubmed, and Embase databases, and the Cochrane Library.
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