Abstract
BackgroundThe success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. We hypothesized that the distribution of glenoid version and especially inclination are underestimated in the shoulder arthritis population, and also that superior glenoid inclination can be detected through 3-dimensional (3D) software program of computed tomography (CT) to a greater proportion in patients with rotator cuff insufficiency, but also in patients with osteoarthritis with an intact rotator cuff. Because of the influence of rotator cuff imbalance on secondary glenoid wear the values of the critical shoulder angle (CSA) and the fatty infiltration of the rotator cuff are further analyzed. The aim of our study is to determine; 1) the distribution of glenoid inclination and version; 2) the relationship between glenoid inclination, version, the critical shoulder angle (CSA) to the status of the rotator cuff; 3) the proportion of patients with both an intact rotator cuff and a superior inclination greater than 10°.MethodsA total of 231 shoulders were evaluated with X-ray images, 3-dimentional (3D) software program of computed tomography (CT), and magnetic resonance imaging. The cohort was divided into 3 groups according to their inclination angles and also grouped as intact-rotator cuff and torn-cuff group.ResultsThe median (min/max) values for the 231 shoulders were 8° (− 23°/56°) for the inclination angle, − 11°(− 55°/23°) for the version angle, and 31.5°(17.6°/61.6°) for the CSA. The majority of the glenoids were found to show posterior-superior erosion. Glenoid inclination angle and CSA were significantly higher in torn-cuff group when compared with intact-cuff group (P < 0.001, both). The rotator cuff tears were statistically significant in high inclination group than low inclination group and no inclination group (p < 0.001). In the high inclination group, 41 of 105 (39%) shoulders had an intact rotator cuff, in about 18% of all shoulders.ConclusionOur findings show that 3D evaluation of glenoid inclination is mandatory for preoperative planning of shoulder replacement in order to properly assess superior inclination and that reverse shoulder arthroplasty may be considered more frequently than as previously expected, even when the rotator cuff is intact.Level of evidenceLevel III.
Highlights
The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis
We retrospectively evaluated the preoperative characteristics of patients with primary and secondary osteoarthritis and rotator cuff arthropathy scheduled for primary shoulder replacement at our institution between March 2015 and March 2018
Glenoid version angle was not correlated with critical shoulder angle (CSA) (r = − 0.05, P = 0.41; Table 1)
Summary
The success of shoulder arthroplasty, both reverse and anatomical, depends on correcting the underlying glenoid deformity especially in patients with an osteoarthritis. The glenoid inclination angle has been proposed as an important characteristic of glenoid pathology because this angle may be associated with rotator cuff tears, as well as with superior migration of the humeral head [5,6,7]. Another commonly used characteristic of the glenoid, the critical shoulder angle (CSA) defined by Moor, seems to be closely related to glenoid inclination [5, 8]. Guidelines for selecting implant design have been established, as have 2D-classifications of glenoid deformities: the transversal plane by Walch et al [4] and in the coronal plane by Sirveaux and Favard [11]
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