Reverse Shoulder Arthroplasty Group Research Articles

Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review.

Background: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. Methods: Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. Results: Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. Conclusions: The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.

Total Shoulder Arthroplasty Versus Reverse Shoulder Arthroplasty in Primary Glenohumeral Osteoarthritis With Intact Rotator Cuffs: A Meta-Analyses.

Traditional practice favors total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (PGHO) with an intact rotator cuff; however, the indications for reverse shoulder arthroplasty (RSA) have expanded to include PGHO. The purpose of this systematic review is to compare the mean differences in the range of motion and patient-reported outcomes between the TSA and RSA with an intact rotator cuff and to analyze the subgroup of the Walch type B2 glenoid. This IRB-exempt, PROSPERO-registered systematic review strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. A literature search of five databases revealed 493 articles, of which 10 were included for quantitative synthesis. Level III evidence studies with the diagnosis of PGHO and ≥2 years of follow-up were included. Studies without preoperative and postoperative data were excluded. The Newcastle-Ottawa scale was used to evaluate the methodologic quality of the included studies. Preoperative and postoperative range of motion and patient-reported outcomes were collected. The random-effects model was employed, and p < 0.05 was considered statistically significant. There were a total of 544 and 329 studies in the TSA group and RSA group, respectively. The mean age in the TSA group and RSA groups were 65.36 ± 7.06 and 73.12 ± 2.40, respectively (p = 0.008). The percentages of males in the TSA and RSA groups were 73.2% and 51.1%, respectively (p = 0.02). The mean differences in forward elevation, external rotation in adduction, internal rotation scale, visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Single AssessmentNumericEvaluation (SANE) scores were improved for both groups with no significant differences between the two. There were 9.6 times the revisions in the TSA group (8.8% vs. 0.91%; p = 0.014) and 1.5 times the complications in the TSA group (3.68% vs. 2.4%; p = 0.0096). Two hundred and forty-two glenoids were identified as Walch type B2 (126 in the TSA groupand 116 in the RSA group). The mean ages in the B2 subgroup were 68.20 ± 3.25 and 73.03 ± 1.49 for the TSA and RSA, respectively (p = 0.25). The percentages of males in the B2 subgroup were 74.6% and 46.5% for the TSA and RSA groups, respectively (p = 0.0003). The ASES, SANE, forward elevation, and external rotation in the adduction results were descriptively summarized for this subgroup, with average mean differences of 49.0 and 51.2, 45.7 and 66.1, 77.6° and 58.6°, and 38.6° and 34.1° for the TSA and RSA groups, respectively. In the setting of primary glenohumeral osteoarthritis with an intact rotator cuff, the RSA has a similar range of motion and clinical outcomesbut lower complication and revision rates as compared to the TSA. This may hold true in the setting of the B2 glenoid, although a high-powered study on this subgroup is required. Anatomic shoulder arthroplasty maintains an important role in select patients. Further studies are required to better elucidate the role of glenoid bone loss and posterior humeral head subluxation with regard to implant choice.

Clinical Outcomes of Arthroscopic Superior Capsular Reconstruction Using Fascia Lata Autograft Versus Reverse Shoulder Arthroplasty in Patients 65 Years and Older With Irreparable Rotator Cuff Tears: A Retrospective Cohort Study.

Arthroscopic superior capsular reconstruction (ASCR) and reverse shoulder arthroplasty (RSA) have both shown favorable outcomes in patients with irreparable rotator cuff tears (IRCTs). To (1) compare the clinical outcomes of ASCR versus RSA in patients aged ≥65 years with IRCTs and (2) compare serial changes in clinical outcomes between treatment groups. Cohort study; Level of evidence, 3. This study included patients with IRCTs without glenohumeral osteoarthritis who underwent either ASCR or RSA between March 2013 and December 2020 and had at least 2 years of follow-up data. We assessed active range of motion, a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, and the Single Assessment Numeric Evaluation (SANE) score at the preoperative, short-term (postoperative 6-12 months), and final follow-up times. In total, 64 patients (ASCR, 31 patients; RSA, 33 patients) were included. The mean age of patients was 71.3 ± 4.4 and 72.9 ± 4.1 years, and the mean final follow-up duration was 42 ± 21.8 and 37.7 ± 21.7 months in the ASCR and RSA groups, respectively. At the short-term follow-up, RSA achieved significant improvements in all clinical outcomes, except for internal rotation (IR), while ASCR only showed significant improvements in VAS pain, ASES, and SANE scores. Compared with the preoperative period, both ASCR and RSA achieved significant improvements in all clinical outcomes, except for IR in the RSA group at the final follow-up. The ASCR group achieved better IR and ASES scores at the final follow-up, while the time taken to recover from pseudoparalysis was shorter after RSA. The ASCR group showed a 67.8% graft healing rate at the 1-year follow-up, while the RSA group showed 12.1% of scapular notching at the final follow-up. No other postoperative complications were observed in either group. ASCR and RSA achieved favorable clinical outcomes in the study cohort. At the short-term follow-up, RSA showed significant improvements in all clinical outcomes, except for IR, while ASCR only showed significant improvements in VAS pain, ASES, and SANE scores. At the final follow-up, however, ASCR had better IR and ASES scores compared with RSA.

Mid-term Results Following Reverse Shoulder Arthroplasty and the Role of Navigation in the Management of Glenoid Bone Loss.

Background Inaccurate positioning of the glenoid component has been well described as the most common cause of early failure following a reverse shoulder arthroplasty (RSA). Among the latest developments in operative technique, three-dimensional preoperative planning and navigation intraoperative systems have been developed to improve the accuracy of the baseplate positioning during RSA. The primary purpose of this retrospective analysis was to investigate the mid-term results of patients who underwent an elective RSA or for acute highly comminuted proximal humerus fractures. The secondary goal was to investigate the role of navigation in the execution of preoperative planning, especially in the management of glenoid bone loss. Methodology In total, 101 cases were included in this study. Patients were divided into the following two groups: 88 cases of RSA performed without the use of navigation (conventional RSA) and 13 cases performed using intraoperative navigation (navigated RSA). For all patients included in the study, preoperative planning software was employed. Patient demographics, gender, past medical history, indication of procedure, operated site, type of glenoid component used, length of baseplate screws, and clinical assessment scores (Oxford Shoulder Score, OSS) were reported for all patients. Cases of revision shoulder arthroplasty were excluded from this study. Results The postoperative clinical assessment of patients revealed that following RSA, all patients improved significantly with a consistently upward trend of the OSS noted for both groups (conventional and navigated RSA) throughout the postoperative assessment. Despite no statistically significant difference detected, the clinical scores of the navigated RSA group outperformed those of the conventional RSA group in the postoperative period. A higher incidence of augmented baseplate use was noted in the navigated RSA group than in the conventional group (23.07% vs. 5.68%, p < 0.001). Conclusions Our results indicate that the use of intraoperative navigation appears to be a valuable tool in preoperative planning, providing accurate positioning of the baseplate, a better understanding of the glenoid anatomy, and real-time monitoring of the length and direction of the baseplate screws. It is difficult to conclude if the use of navigation leads to superior clinical outcomes, and the cost-effectiveness of its use needs to be further analyzed. Prospective randomized trials are required to assess the cost-effectiveness of routine use of navigation in RSA.

BIO-RSA vs metal augmented baseplate in shoulder osteoarthritis with multiplanar glenoid deformity: a comparative study of radiographic findings and patient outcomes.

Reverse shoulder arthroplasty (RSA) requiring extensive reaming to address severe glenoid bone loss increases the risk of glenoid medialization and baseplate failure. We hypothesized that i) metal augmented baseplate prevents the medialization of the joint line and preserves glenoid bone stock similarly to BIO-RSA; ii) bone graft viability and healing in BIO-RSA patients become compromised over time. Eighty-one patients (83 shoulders) underwent glenoid lateralization with bone (BIO-RSA group, 44) or metal augmented baseplate (MIO-RSA group, 39) and a minimum follow-up of 24 months were included. The orientation and direction of glenoid erosion was identified and recorded using computerized 3D planning. Active range of motion, and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index were assessed before arthroplasty and at the last follow-up visits. Radiographic changes around the glenoid and humeral components were assessed. Healing and thickness of bone graft were evaluated by predefined criteria. Postoperative global glenoid inclination (β angle) and retroversion were also measured. Delta scores of active anterior elevation were higher in the MIO-RSA group (p= 0.027). The differences in the other planes of shoulder motion and in WOOS index scores between the groups were not significant. Preoperative glenoid retroversion was higher in BIO-RSA patients, glenoid inclination was similar in both groups. Type B2 and B3 glenoids had a posterior-central (91%) and posterior-superior (90%) erosion with a mean posterior humeral head subluxation of 76% and 78%, respectively. The direction of erosion in Type E2 and E3 glenoids was posterior-superior, with a mean posterior humeral head subluxation of 74%. The rate of high position of the glenosphere was higher in the BIO-RSA group (p = 0.022), while the values of β angle and postoperative retroversion were similar in the two groups. BIO-RSA group showed radiolucent lines < 2mm around the bone graft in 16 patients (36.4%) and decreased thickness in 15 (34.1%). Incomplete baseplate seating was found in 4 MIO-RSA patients (10%). We found higher rate of humerus condensation lines in MIO-RSA patients (p= 0.01) and higher rate of cortical thinning and tuberosity resorption in the BIO-RSA group (p= 0.027 and p = 0.004, respectively). Metal augmented glenoid is a suitable alternative to BIO-RSA to preserve bone and prevent the medialization of the joint line in arthritic glenoid with multiplanar glenoid deformity. Bone and metal augmentation provided satisfactory clinical outcomes. Bone graft resorption in BIO-RSA patient raise concern about the risk of baseplate loosening and requires further long term studies.

Arthroscopic superior capsular reconstruction versus reverse shoulder arthroplasty in patients with massive irreparable rotator cuff tears: A comparative clinical study.

This study aimed to compare the clinical and functional outcomes of reverse shoulder arthroplasty versus arthroscopic supe- rior capsular reconstruction in the treatment of patients with massive irreparable rotator cuff tears and Hamada grade 1-2 glenohumeral arthritis. It is a retrospective case-control study comparing the prospective results of 2 different treatment methods. This retrospective comparison of groups was conducted between May 2016 and May 2020. The study included 40 people with massive irreparable rotator cuff tear and Hamada grade 1-2 arthropathy who had arthroscopic superior capsular reconstruction with tensor fascia latae autograft or reverse shoulder arthroplasty surgery. Patients were divided into 2 groups according to treatment. Clinical outcome measures included shoulder range of motion, pain, and functional scores (Constant-Murley, American Shoulder and Elbow Surgeons). The mean age was 61.85 ± 7.56 and 71.10 ± 6.42 years, respectively, for group I [superior capsular reconstruction (n=20)] and group II [superior capsular reconstruction (n=20)]. The mean follow-up was 22.30 ± 8.4 and 32.50 ± 8.11 months, respectively. In the postoperative data, flexion degrees and Constant scores were significantly higher in the superior capsular reconstruction group (P=.007, P = .043). No significant difference was found between the 2 groups in all parameters (P > .05) except abduction. The increase in abduction value in the reverse shoulder arthroplasty group was significantly higher than in the superior capsular reconstruction group (P = .003). In addition, postoperative data in all parameters in both groups showed significant changes compared to preoperatively. This study has shown that superior capsular reconstruction with tensor fascia latae autograft can provide clinical and func- tional improvement similar to the reverse shoulder arthroplasty procedure in treating massive irreparable rotator cuff tears with Hamada grade 1-2 arthropathy. Level III, Therapeutic Study.

Improvement in Sleep Disturbance Following Anatomic and Reverse Shoulder Arthroplasty.

Sleep disturbance is commonly reported by patients with arthritis and rotator cuff disease. Small cohort studies have demonstrated sleep improvements following anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). However, to our knowledge, no large cohort study has evaluated sleep improvement after shoulder arthroplasty. The purpose of the present study was to determine the effects of shoulder arthroplasty on sleep improvement, including the speed of sleep recovery, improvement plateaus, and any differences observed between TSA and RSA. A retrospective analysis of our institution's shoulder and elbow repository evaluated patients who had been managed with TSA and RSA between 2012 and 2021. Our analysis focused on visual analog scale (VAS) pain scores as well as specific sleep-related questions included in the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Preoperative characteristics were compared, and comparisons at the 3-month, 6-month, 1-year, and most recent follow-ups were performed to evaluate the efficacy of improvement, speed of recovery, improvement plateaus, and differences among implant types. Our search identified 1,405 patients who were treated with shoulder arthroplasty, including 698 who underwent TSA and 707 who underwent RSA. Six hundred and seventy-six (97%) of those who underwent TSA and 670 (95%) of those who underwent RSA reported sleep disturbance prior to surgery and were eligible for inclusion. With the exclusion of 357 patients without complete follow-up, 989 patients (517 who underwent TSA and 472 who underwent RSA) met the inclusion criteria, with a median follow-up of 36 months for the TSA group and 25 months for the RSA group. Postoperatively, significant improvements in the ability to sleep comfortably and sleep on the affected side were observed in both the TSA group and the RSA group (p < 0.001). The ability to sleep comfortably returned faster than the ability to sleep on the affected side, with the ability to sleep comfortably reaching a plateau at 3 months and the ability to sleep on the affected side reaching a plateau at 6 months. Despite improvements in terms of sleep disturbance, at the time of most recent follow-up, 13.2% of patients in the TSA group and 16.0% of those in the RSA group could not sleep comfortably and 31.4% of those in the TSA group and 36.8% of those in the RSA group could not sleep on the operative side. The results of the study demonstrated that both TSA and RSA provide significant and rapid improvement in patients' ability to sleep comfortably and, to a lesser extent, improves their ability to sleep on their affected side. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Return to sports and physical work after anatomical and reverse shoulder arthroplasty.

No consensus has been reached on the return to sports or physical work after shoulder arthroplasty due to a shortage of literature. The purpose of this study was to investigate return to sports or physical work after anatomical total shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (RSA), as well as the clinical and radiographic outcomes. The inclusion criteria were as follows: 1) aTSA or RSA between 2012 and 2017, and 2) patients who preoperatively participated in sports or physical work. The exclusion criteria were as follows: 1) revision arthroplasty, 2) fracture/dislocation, 3) fracture sequelae, 4) postinfection, and 5) <2-year follow-up. Sports and physical work were classified as low-, medium-, or high-load activities. Range of motion, Constant score, sport or work return, and radiographic findings were evaluated and compared between aTSA and RSA groups. The subjects who met the criteria were 90 shoulders in 86 patients. The aTSA group consisted of 30 shoulders (10 men and 20 women) with a mean age of 71±8years (range, 56-85). The RSA group consisted of 60 shoulders (39 men and 21 women) with a mean age of 72±6years (range, 56-83). Active range of motion significantly improved after surgery in all directions in the aTSA group but only in flexion and external rotation in the RSA group. Postoperative external and internal rotations, as well as postoperative Constant scores and satisfaction, were significantly better in the aTSA than in the RSA group. In the aTSA group, the return rate was 93%, and the complete return rate was 70%. In the RSA group, the return rate was 83%, and the complete return rate was 30%. The complete return rate was significantly higher in the aTSA than in the RSA group. Only one aTSA shoulder showed loosening of the glenoid implant, and 8 RSA shoulders demonstrated low-grade scapular notching. The return to sports or physical work rates after aTSA and RSA were high; however, the complete return rates were significantly higher in the aTSA group than in the RSA group. No radiographic failures were identified except for one asymptomatic glenoid loosening with a midterm follow-up.

Superior Outcomes with Reverse Shoulder Arthroplasty Versus Nonoperative Management for Proximal Humerus Fractures: A Matched Cohort Analysis.

To evaluate early outcomes (within 1 year) for geriatric proximal humerus fractures managed nonoperatively or with reverse shoulder arthroplasty (RSA). Retrospective cohort Setting: Academic level 1 trauma center, level 2 trauma/geriatric fracture centerPatients/Intervention: 71 patients with proximal humerus fractures that underwent nonoperative management or RSA, matched by age, comorbidity burden, and fracture morphology. Patient reported outcomes, range of motion, and complications rates within 1 year of treatment. RSA patients demonstrated greater active forward flexion (aFF) and external rotation compared to nonoperative patients throughout the first 6 months after treatment (p<0.05 for all). RSA patients achieved satisfactory ROM (>90° aFF) at higher rates than nonoperative patients (96.2% vs 62.2%, p<0.01). RSA led to significantly lower shoulder pain and PROMIS pain interference scores throughout the first year post-treatment (p<0.05). PROMIS physical function scores were also higher in the RSA group at 3 months, 6 months, and 1 year compared to the nonoperative group (p<0.05 for all). Similar complication rates were experienced in both groups (nonoperative=8.9%, RSA=7.7%; p=0.36). In an age, comorbidity and fracture morphology matched analysis, treatment of proximal humerus fractures with RSA is associated with greater shoulder ROM throughout the first 6 months of treatment, decreased pain, and improved physical function compared to nonoperative management, without significant differences in short term complications. These results suggest that RSA may be superior to nonoperative management during the early recovery period for proximal humerus fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Anatomic shoulder arthroplasty with high side reaming versus reverse shoulder arthroplasty for eccentric glenoid wear patterns with an intact rotator cuff: comparing early versus midterm outcomes with minimum 7 years of follow-up.

Eccentric glenoid bone loss patterns (B- and C-type glenoid) pose a difficult challenge when performing shoulder arthroplasty. Anatomic total shoulder arthroplasty with preferential high-side reaming (ATSA+HSR) has been an accepted method to treat this problem. Reverse shoulder arthroplasty (RSA) has become an alternative method to manage these cases with eccentric glenoid wear. The purpose of this study was to compare the early 2-year outcomes with the midterm outcomes for patients who underwent ATSA+HSR vs. RSA for eccentric glenoid wear patterns with an intact rotator cuff. From 2008 to 2014 there were 242 shoulder arthroplasties performed in the setting of eccentric glenoid wear patterns. Of that initial cohort 101 ATSA+HSR and 93 RSA had both 2-year and final follow-up with a minimum of 7 years from surgery. American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST), range of motion, patient satisfaction, and radiographs were evaluated for each cohort and contrasted at the 2-year follow-up point and last follow-up time point. The average follow-up in the ATSA+HSR cohort was 8.3 years compared with 7.8 years in the RSA cohort. At the 2-year follow-up point, the ATSA+HSR group had better average ASES scores (85 vs. 80 [P<.001]), SST scores (10 vs. 9.6 [P<.001]), forward elevation (162° vs. 151° [P<.001]), external rotation (47° vs. 42° [P<.001]), and internal rotation (IR) (80% full IR vs. 55% full IR [P<.001]). At the 2-year follow-up, 95% of the ATSA+HSR cohort were satisfied compared with 93% in the RSA cohort. At the final follow-up, the RSA group had better average ASES scores (80 vs. 77 [P<.001]) and SST scores (9.4 vs. 8 [P<.001]) and a similar forward elevation (152° vs. 149° [P=.025]). The ATSA+HSR had better external rotation (45° vs. 41° [P<.001]) and IR (74% full IR vs. 54% full IR [P=.005]). Patient satisfaction at the final follow-up had decreased to 82% in the ATSA+HSR group, compared with 95% satisfied in the RSA group. Of the initial ATSA+HSR cohort, 8% of patients had undergone revision compared with 2% in the RSA cohort. ATSA with HSR had better outcome scores and range of motion with a similar patient satisfaction rating to RSA at the 2-year point. Over time, the ATSA+HSR results deteriorated, and at the final midterm follow-up, the RSA group had more durable results with better outcome scores, a higher patient satisfaction rating, and a lower revision rate.

Scapulohumeral rhythm in shoulders with reverse shoulder arthroplasty measured with a new portable three-dimensional scapular kinematics assessment system.

Reverse shoulder arthroplasty (RSA) is a valid and increasingly popular treatment option in eccentric arthrosis and cuff arthropathy. We know that the deltoid is the motor of RSA. However, the role of scapular motion has been poorly documented in the literature. The aim of our study is to analyze and quantify the role of the scapular contribution in the functional outcome of patients undergoing RSA. Fourteen patients who underwent primary RSA were included in the study. In all cases, a reverse prosthesis with lateralizing stem was implanted. All patients underwent clinical examination, video recording, and motion analysis. X-ray and postoperative CT examinations were collected to evaluate positioning and any loosening. ShowMotion (NCS Lab srl, Modena, Italy) 3D kinematic tracking system was used to evaluate and measure the scapular motion in 3 planes. All patients show substantial amount of posterior tilting and lateral rotation starting at 30° in forward elevation. A further difference is the anticipation of the retraction during the range of motion in the RSA side. The contribution of scapular motion in the RSA shoulder was greater than in the healthy shoulder. In patients with bilateral RSA, the contribution of scapular motion was higher in tilting and lateral rotation in the worse shoulder side in terms of range of motion. This means that to compensate for the loss of glenohumeral motion in RSA, more scapula-thoracic motion is needed to obtain the same thoraco-humeral elevation angle. In the light of what has been measured, the post-RSA scapular kinematics has typical characteristics that must be achieved in order to obtain a good functional outcome. We can conclude that on the RSA side, the patients anticipate upward rotation both in flexion and abduction. The contribution of the upward rotation to elevation in the RSA group is therefore more significant. In addition to this, to facilitate elevation movements, there is an anticipation of the scapular retraction and a more prominent tilt resulting in different scapular kinematics. The analysis of scapular motion could be useful in the postoperative follow-up of patients undergoing RSA surgery and improve adaptative physiotherapy protocols. It potentially can even be included in future arthroplasty planning systems.

Comparison of reverse shoulder arthroplasty and total shoulder arthroplasty for patients with inflammatory arthritis.

End-stage glenohumeral joint arthritis is common in patients with inflammatory arthritis. Reverse shoulder arthroplasty (RSA) and anatomic total shoulder arthroplasty (TSA) are both indicated in this setting. RSA is often considered based on the impacts of long-standing inflammatory arthritis including glenoid and humeral bone erosion and rotator cuff insufficiency. However, acromial and scapular spine fractures following RSA have been reported more commonly in these patients, which can have a significant impact on outcomes. Currently, no study has directly compared the efficacy and complication rates of RSA vs. TSA in patients with inflammatory arthritis. This study aimed to investigate differences in clinical outcomes and complications in patients undergoing RSA vs. TSA with glenohumeral inflammatory arthritis. We performed a retrospective review of 86 patients with inflammatory arthritis treated with primary RSA (n=43) or TSA (n=43) with a minimum of 2 years' follow-up. American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores, visual analog scale scores for pain and function, active range of motion, and patient self-ratings of upper-extremity normality (Subjective Assessment of Normal Evaluation [SANE]) were collected preoperatively and at minimum 2-year follow-up. Radiographic classification of preoperative glenoid and humeral bone loss was performed, and postoperative complications were observed. Revision and complication details were compared. The study cohort had an average age of 72.1 years (range, 31-92 years) and average follow-up period of 51.6 months (range, 22-159 months). Both the RSA and TSA cohorts demonstrated improvements in patient-reported outcome measures and ranges of motion; however, patients treated with TSA showed a greater postoperative final Simple Shoulder Test score (P<.001), visual analog scale score for function (P=.0347), active elevation (P=.0331), active external rotation (P<.001), active internal rotation (P=.005), and Single Assessment Numeric Evaluation (SANE) score (P=.0161). Analysis of complication rates demonstrated no statistically significant difference between cohorts. Four acromial fractures occurred in the RSA group. When RSA patients who sustainedacromial fractures were removed from the analysis, there were minimal differences in outcomes between the RSA and TSA cohorts. TSA in patients with inflammatory arthritis leads to improved clinical outcomes but higher early revision rates when compared with RSA. RSA outcomes are negatively impacted by a high rate of postoperative acromial fractures.

The quantification of muscle activities during arm elevation following reverse shoulder arthroplasty or superior capsular reconstruction for irreparable rotator cuff tears using positron emission tomography.

Reverse shoulder arthroplasty (RSA) and superior capsular reconstruction (SCR) are recognized as surgical options for an irreparable rotator cuff tear. However, the postoperative changes of the muscle activity patterns remain unclear. The purpose of this study was to investigate the quantified muscle activities on shoulder elevation in patients treated with RSA or SCR using fluorine-18-labelled fluorodeoxyglucose-positron emission tomography. Asymptomatic shoulders that underwent RSA or SCR and those without a rotator cuff tear were analyzed as the RSA, SCR, and control groups. All subjects underwent shoulder elevation exercise, followed by a fluorine-18-labelled fluorodeoxyglucose-positron emission tomography examination. Using previously established methods to quantify the uptake of each muscle on positron emission tomography images, the standard uptake values (SUVs) for 16 portions of the deltoid, rotator cuff, and periscapular muscles were obtained to compare the muscle activity patterns among 3 groups. The deltoid muscle showed the most characteristic differences according to the surgeries. The mean SUVs of the anterior, middle, and posterior deltoid were 3.3, 3.7, and 1.5 for the RSA group; 2.7, 4.2, and 1.5 for the SCR group; and 1.3, 2.0, and 0.9 for the control group, respectively. In comparison to the control group, both the RSA and SCR groups showed significantly increased SUVs at all portions of the deltoid muscle. The RSA group showed similar SUVs for the anterior and middle deltoid, whereas the SCR and control groups showed greatest SUVs at the middle deltoid. In addition, the serratus anterior, levator scapulae, and upper portion of the trapezius in the RSA group showed greater SUVs than in the control group. The deltoid muscle showed increased activity in the RSA and SCR groups. The middle deltoid was mainly used in the SCR group, whereas the anterior and middle deltoid, as well as the upward rotator muscles of the scapula, were mainly used in the RSA group.

Comparative clinical and radiologic evaluation between patients undergoing standard reversed shoulder arthroplasty or bony increased offset.

Modifications of the medialized design of Grammont-type reverse shoulder arthroplasty (RSA) using a bony increased offset (BIO-RSA) has shown better clinical results and fewer complications. The aim of this study is to compare the clinical results, complications, and radiological outcomes between patients undergoing standard RSA and BIO-RSA. A retrospective review was performed of 42 RSA procedures (22 standard RSA and 20 BIO-RSA). With a minimum of 1 year of follow-up, range of motion (ROM), Constant shoulder score (CSS), visual analog scale (VAS), and subjective shoulder score (SSS) were compared. Radiographs and computed tomography (CT) scan were examined for scapular notching, glenoid and humeral fixation, and graft healing. At a mean follow-up of 27.6 months (range, 12-48 months), a significant difference was found for active-internal rotation (P=0.038) and for passive-external rotation (P=0.013), with better results in BIO-RSA. No other differences were found in ROM, CSS (P=0.884), VAS score, and SSS. Graft healing and viability were verified in all patients with CT scan (n=34). The notching rate was 28% in the standard RSA group and 33% in the BIO-RSA group, but the standard RSA had more severe notching (grade 2) than BIO-RSA (P=0.039). No other significative differences were found in glenoid and humeral fixation. Bone-graft lateralization is associated with better internal and external rotation and with less severe scapular notching compared to the standard RSA. Integration of the bone graft occurs effectively, with no relevant changes observed on radiographic evaluation.

Anatomically reduced fixation should always be considered when treating B and C proximal epiphyseal humeral fractures

BackgroundProximal humeral fractures are commonly observed in elderly patients. Management of these injuries is controversial. Literature comparing locking plate fixation, arthroplasty, and conservative treatments show no clear advantages for any of these management strategies. Thus far, no study has considered anatomically reduced fractures obtained after locking plate treatment. To clarify the best surgical procedure in middle-aged patients, we considered outcomes and major complications leading to surgical revision following an anatomically reduced fracture fixed with locking plate and reverse shoulder arthroplasty (RSA) in the treatment of type B/C fractures in patients between 50 and 75 years of age.MethodsThis is a retrospective study including 59 patients between 50 and 75 years of age with type B/C proximal humeral fracture treated with RSA or with locking plate fixation (resulting in an anatomical reduction) between January 2010 and December 2018. Preoperative radiographs and computed tomography (CT) were evaluated in all patients. Clinical and radiologic follow-up was performed using range of motion (ROM), the Constant–Murley Score (CMS), the Oxford Shoulder Score (OSS), the Simple Shoulder Test (SST), the Subjective Shoulder Value (SSV), and visual analog scale (VAS). Major complications were considered.Results In the plate fixation group, ROM, CMS, SST, and VAS were higher than in the RSA group. Lower complication rates compared with the literature were observed in both groups. Anatomically reduced fracture fixed with plate and screw could outperform RSA in terms of outcome. In second-level centers where traumatology is performed by surgeons with great expertise in upper limb trauma, the choice between plate fixation and reverse arthroplasty should be made during surgery.ConclusionAnatomically reduced fractures showed better outcomes compared with RSA in type B/C fractures. Surgeons should always try to perform a reduction of the fracture in order to understand if a plate fixation could be feasible. If it is impossible to perform an anatomical reduction, we suggest to consider RSA. This is a retrospective observational study.

Clinical outcomes of reverse shoulder arthroplasty and rotator cuff repair in patients with massive rotator cuff tears without osteoarthritis: comparison using propensity score matching.

The optimal management for massive rotator cuff tears (MRCTs) without osteoarthritis (OA) remains controversial. The purpose of this study was to evaluate and compare the clinical outcomes of reverse shoulder arthroplasty (RSA) vs. rotator cuff repair (RCR) in patients with MRCTs without OA. We conducted a retrospective data analysis of 68 patients treated for MRCTs via RSA and 215 patients treated for MRCTs via arthroscopic RCR between January 2014 and April 2019. Through propensity score matching, patients were matched for sex, age, tear size, and global fatty degeneration index. Thirty-nine patients in each group were included, and all patients had completed minimal 2-year follow-up. Postoperative radiologic evaluations of healing failure were performed. The visual analog scale score for pain, range of motion, and functional outcome measures including the American Shoulder and Elbow Surgeons score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Simple Shoulder Test score, and Constant score were assessed and compared between the 2 groups. Healing failure was observed in 10 patients in the RCR group (32.3%). No statistically significant differences in preoperative range of motion and functional scores were found between the RCR and RSA groups. Both groups showed significant pain relief and functional improvement at final follow-up. Patients in the RCR group showed significantly greater forward elevation (156.4°±23.8° vs. 139.7°±22.4°, P<.001) and internal rotation (thoracic vertebra, T8.2±1.2 vs. T9.7±2.6, P=.001). The average American Shoulder and Elbow Surgeons score was 88.3±12.2 in the RCR group and 81.8±16.1 in the RSA group (P=.045). The QuickDASH score was significantly higher in the RCR group (P=.019). A significantly higher Simple Shoulder Test score (9.7±2.8 vs. 8.1±3.0, P=.01) and a significantly higher Constant score (67.2±6.5 vs. 63.2±7.1, P=.011) were seen in the RCR group. Both RSA and RCR are effective and reliable treatment options for MRCTs without OA. However, the RCR group showed better shoulder function improvement than the RSA group. Considering the possible implications of RSA, RCR should be referred to as a first-line treatment option for patients with MRCTs without OA with proper indications.

Prosthetic Reconstruction of the Shoulder After Resection of Proximal Humerus Bone Tumor.

Prosthetic reconstruction after wide resection of tumors of the proximal humerus presents a unique challenge. The shoulder is a complex articulation, and patients have high expectations for postoperative function. The goal of this study is to compare functional outcomes, oncologic outcomes, and complication rates for 2 reconstructive methods. Forty patients with proximal humeral tumors were reviewed retrospectively. Proximal humeral endoprosthesis (PHE) was used for 21 patients, and reverse shoulder arthroplasty (RSA) was used for 19 patients. Clinical results, oncologic outcomes, and complication rates were assessed. The functional outcomes of the patients were assessed with the Musculoskeletal Tumor Society scoring system (MSTS), the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and shoulder range of motion. The mean follow-up was 62±15 months. Shoulder dislocations occurred among 8 patients with PHE and 1 patient with RSA (P=.021). The other complication rates were similar for the 2 groups (P<.05). At the latest follow-up, the mean MSTS score was 68±10.3 for those with PHE and 76±7.7 for the patients with RSA (P=.72). However, the QuickDASH score was significantly better (P=.031) for those with RSA (mean, 19±6.3) compared with patients with PHE (mean, 30±4.8). Additionally, shoulder active abduction and forward flexion were significantly greater for the RSA group (P=.04 and P=.03, respectively). Five patients had local recurrence. Prosthetic reconstruction after oncologic re-section of the proximal humerus is associated with significant limitation of shoulder range of motion and a high rate of revision surgery. However, in this study, RSA was associated with fewer dislocations, improved Quick-DASH score, and greater abduction and forward flexion compared with PHE. [Orthopedics. 2022;45(6):e335-e341.].

Reverse shoulder arthroplasty vs. hemiarthroplasty for the treatment of osteoporotic proximal humeral fractures in elderly patients: A systematic review and meta‑analysis update.

The present meta-analysis was conducted to compare the safety and effectiveness of reverse shoulder arthroplasty (RSA) and hemiarthroplasty (HA) in the treatment of osteoporotic proximal humeral fractures in elderly patients. The Embase, Pubmed Central, Cumulative Index to Nursing and Allied Health Literature, ProQuest Dissertations and Theses, Cochrane Library and Chinese Biomedical databases were searched between January 2009 and January 2022 to identify relevant studies. According to the search strategy, a total of 210 associated studies were retrieved and 16 were finally included. Review Manager 5.4 software was used for the data analysis. This study indicated that patients in the RSA group had significantly improved treatment outcomes compared with patients in the HA group, as assessed by Constant-Murley Shoulder Outcome Score (95% CI, 1.69-3.76; P<0.001), American Shoulder and Elbow Surgeons score (95% CI, 11.81-24.88; P<0.001) and shoulder range of motion (ROM; 95% CI, 3.41-9.07; P<0.001). However, the HA group was superior to the RSA group in terms of the Oxford Shoulder score (95% CI, 2.89-11.11; P<0.001). There was no significant statistical difference between the two groups in terms of the Disabilities of the Arm, Shoulder and Hand score and complications. Overall, for the treatment of osteoporotic proximal humeral fractures in the elderly, the RSA group had improved postoperative ROM and functional scores compared with the HA group, without significant difference in the incidence of complications. However, HA remains a safe and reliable treatment option.

Surgical treatment for acute and displaced proximal humerus fractures in elderly patients: hemiarthroplasty vs. reverse shoulder arthroplasty

BackgroundProximal humerus fractures (PHFs) are the third most common fractures in elderly patients. The best treatment option on this population is still a topic of discussion. Reverse shoulder arthroplasty (RSA) has increased popularity as a viable treatment option for these fractures. Yet, few studies demonstrate the risk factors for mortality after this procedure. MethodsThe authors present a retrospective study including patients older than 75 y with acute and displaced PHFs primarily treated with RSA or hemiarthroplasty in a public hospital between January 2004 and January 2020. The exclusion criteria were pathologic fractures and more than 6 weeks to surgery. Survival curves were obtained using the Kaplan-Meier method and the log-rank test was performed to compare survival rates. ResultsA total of 73 patients met the inclusion criteria. The mean age at the time of fracture and surgery was 78 y old, 10 males and 63 females, with a median clinical follow-up of 64 months (standard deviation 34). Forty-one patients (56%) had an American Society of Anesthesiologists score of 2. Twenty-eight patients were submitted to hemiarthroplasty and 45 to RSA. Regarding hemiarthroplasty, only one patient with hemiarthroplasty died within a year, and the 5 y survival rate was 70%. Concerning to RSA group, five patients died within a year, and the survival rate at 5 y was 66.2 %. The American Society of Anesthesiologists score (P < .001) was the only risk factor identified for mortality at 5 y. Hemiarthroplasties had more prosthetic loosening compared with RSA (P = .024). Three hemiarthroplasties were converted to RSA, and we verified 1 RSA infection. In the group of hemiarthroplasties, 56% returned to their normal daily living activities, while in the RSA 92% did that, representing a significant difference (P = .007). ConclusionRSA as a primary treatment for displaced PHFs had a high survival rate (88.9% at 1 year and 66.2% at 5 y) and better functional results comparing to patients treated with hemiarthroplasty. With proper patient selection, RSA is a safe procedure for the treatment of PHF, especially in an elderly population.

Contribution of shear wave elastography in evaluation of the deltoid in reverse shoulder arthroplasty: reproducibility study and preliminary results

The current difficulty of reverse shoulder arthroplasty (RSA) is soft tissue management, and adequate deltoid tensionand at present there is no consensus and available tools (X-ray, MRI, EMG) remain difficult to apply in clinical follow-up.The objective of this study was (1) to determine reliability and feasibility of deltoid elasticity assessment using ultrasound elastographyand (2) to assess the change of deltoid stiffness after RSA by comparing shear wave speed (SWS) between healthyand RSA shoulders. Twenty-six healthy (native shoulder, painless and complete range of motion)subjects and twelve patients with RSA were included. Two independent investigators performed 3 measurements on each segment.Measurements were bilateral. Anterior segment was also evaluated at 45° and 60° of passive abduction. Reliability andfeasibility have been assessed (ISO5725-standard). Coefficient of measurements variation was less than 6.1% and0.13 m/s. In the healthy group, SWS was not significantly different between anterior and middle segments; however, the SWSof the posterior segment was significantly lower than others (p<0.0001). In abduction position, compared to the rest position,SWS of the anterior segment decreased at 45° abduction (p=0.0003) and increased at 60° abduction (p<0.0001). Variability ofmeasurement was higher in the RSA group. No significant difference was found between the SWS measurement of the operatedand non-operated side. SWS measurements of the operated side of the anterior and middle segment were significantlyhigher compared to the healthy group. In abduction position, compared to rest position, no difference in SWS of the anteriorsegment was found at 45° abduction (p=0.71) and nor at 60° abduction (p=0.75). This study demonstrated feasibilityand reliability of shoulder assessment with shear wave elastography. Reference values for asymptomatic patients canalready be used in future studies on shoulder pathology and surgery.