Reverse shoulder arthroplasty vs BIO-RSA: clinical and radiographic outcomes at short term follow-up

Nathan Kirzner,Ash Moaveni,Eldho Paul

doi:10.1186/s13018-018-0955-2

Nathan Kirzner, Ash Moaveni + Show 1 more

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https://doi.org/10.1186/s13018-018-0955-2

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Abstract

BackgroundBony increased-offset reverse shoulder arthroplasty (BIO-RSA) may address issues such as inferior scapular notching, prosthetic instability and limited postoperative shoulder rotation; all of which have been reported with the standard RSA and attributed to the medialized design. We hypothesised that this lateralization may increase the rate of scapular stress fractures.MethodsA retrospective review of prospectively collected data was performed on patients who had undergone a RSA between January 2013 and October 2016. A comparative cohort study was designed to compare patients with a standard Grammont-style RSA to those with a BIO-RSA using the same implant. Functional outcome was measured by the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the Subjective Shoulder Value (SSV), the Western Ontario Osteoarthritis of the Shoulder (WOOS) index and pain scores. Radiographs were obtained for all patients and examined for the presence of scapular fracture as well as scapular notching and graft incorporation.ResultsA total of forty patients (22 patients in the standard RSA cohort and 18 with BIO-RSA) were included in the study. Patient characteristics (including age, gender, length of follow-up, dominant side and osteoporosis) were similar in both groups (p > 0.05). The average postoperative follow-up was 20 months (range 12–48 months). There was bone graft incorporation in all BIO-RSA patients at the final radiological follow-up, with no evidence of graft resorption. The overall scapular stress fracture rate was 12.5% (9.1% in the standard RSA and 16.7% in the BIO-RSA). The rates were similar in both cohorts (p = 0.64). All fractures were managed conservatively. To determine whether the presence of a scapular stress fracture had an influence on outcomes, the cohort was divided into cases with and without fracture. Patients with a stress fracture had worse ASES (p = 0.028) and WOOS (p = 0.048) scores. Additionally, osteoporosis was present more commonly in the fracture group (80% vs 17%; p = 0.01). A statistically significant difference was identified when comparing the rates of scapular notching between standard RSA and BIO-RSA cohorts (68% vs 33%; p = 0.028). Furthermore, when notching was present, significantly worse outcome scores were present in all outcome measures (p < 0.001).ConclusionThe BIO-RSA technique was associated with an increase in scapular stress fracture rate when compared to the standard RSA; however, this was not found to be significant. Furthermore, both techniques resulted in similar improvements in the measured functional outcomes. BIO-RSA, however, was associated with a lower scapular notching rate, justifying further evaluation of this technique.Level of evidenceRetrospective cohort study, level III

Highlights

Bony increased-offset reverse shoulder arthroplasty (BIO-Reverse shoulder arthroplasty (RSA)) may address issues such as inferior scapular notching, prosthetic instability and limited postoperative shoulder rotation; all of which have been reported with the standard RSA and attributed to the medialized design
Functional outcomes were measured by the American Shoulder and Elbow Surgeons (ASES) Shoulder Score [18], the Subjective Shoulder Value (SSV) [19] and Western Ontario Osteoarthritis of the Shoulder (WOOS) index [20]
Standard RSA was performed in 22 patients (55%) with the Bony increased-offset reverse shoulder arthroplasty (BIO-RSA) technique employed in 18 patients (45%)

Summary

Introduction

To address the problems of a medialized center of rotation reverse design, several design modifications have been introduced, including lateralized glenospheres, humeral lateralization and use of a bone graft under the baseplate, the so-called bony increased-offset reversed shoulder arthroplasty (BIO-RSA) [10]. Whilst this has shown good effect in decreasing the rates of scapular notching [11] and improving Constant scores, range of motion and pain scores [10, 12], the increased deltoid tension produced by excessive lateralization and humeral lengthening may lead to complications. One possible complication may be of a scapular stress fracture, with rates between 0.9% and 10% reported in the literature [3, 13, 14]

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