Clin Shoulder Elb Search

CLOSE


Clin Shoulder Elb > Volume 27(1); 2024 > Article
Hao, Cueto, Gharby, Freeman, King, Wright, Almader-Douglas, Schoch, and Werthel: Influence of lateralized versus medialized reverse shoulder arthroplasty design on external and internal rotation: a systematic review and meta-analysis

Abstract

Background

Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA.

Methods

We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Meta-analysis was conducted using a random-effects model.

Results

Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°–44°] vs. 27° [22°–32°], P<0.001) and postoperative improvement in ER (20° [15°–26°] vs. 10° [5°–15°], P<0.001). Lateralized implants with subscapularis repair or medialized implants without subscapularis repair had significantly greater postoperative ER and postoperative improvement in ER compared to globally medialized implants with subscapularis repair (P<0.001 for both). Mean postoperative IR was reported in 56% (n=18) of studies and achieved the minimum necessary IR in 51% of lateralized (n=325, 5 cohorts) versus 36% (n=177, 5 cohorts) of medialized implants.

Conclusions

Lateralized RSA produces superior axial rotation compared to medialized RSA. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater axial rotation compared to medialized RSA with subscapularis repair.

Level of evidence

2A.

INTRODUCTION

Since its first description by Grammont in 1985 [1,2], the design of reverse shoulder arthroplasty (RSA) has evolved considerably. While effective at alleviating pain and improving overhead range of motion (ROM), initial reports showed poor restoration of satisfactory external and internal rotation (ER and IR, respectively) [3,4]. Consequently, these reports led many to believe that RSA leads to poor active ER and poor active and passive IR. Nevertheless, it appears that, despite these reported limitations in measured axial ROM, patients can manage toileting (which requires active IR) after unilateral and even after bilateral RSA [5-7].
It has been hypothesized that poor postoperative ER occurs with a lack of tensioning of the posterior rotator cuff secondary to medialization of the greater tuberosity. Similarly, it is believed that loss of passive IR is due to mechanical impingement between the humeral implant and the scapular neck. These hypotheses informed the evolution of the modern lateralized RSA, which is believed to provide tension to the posterior rotator cuff and posterior deltoid to restore active ER and increase impingement-free ROM, improving active and passive IR. However, clinical studies demonstrating a superior axial ROM for lateralized versus Grammont-style RSA are rare because they require surgeons to implant prostheses of varying designs. Furthermore, successful repair of the subscapularis is believed by many surgeons to influence postoperative ROM, although clinical evidence is variable [8-10].
The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset on axial rotation after RSA. Secondarily, we sought to assess the influence of the interaction between medio-lateral implant offset and subscapularis management (repair or spared versus no repair) on axial rotation. We hypothesized that lateralized RSA would be associated with superior axial rotation.

METHODS

This systematic review was performed in accordance with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [11].

Eligibility Criteria

We included original studies reporting on axial rotation after RSA for cuff tear arthropathy, irreparable rotator cuff tear, primary osteoarthritis, or osteoarthritis with rotator cuff deficiency. Studies were excluded if they were a duplicate, written in a language other than English, a review or meta-analysis, a case report or series reporting on fewer than five patients, a commentary or editorial, part of the gray or unpublished studies, an in silico (computer simulation) or in vitro (purely biomechanical or anatomical) study, not assessing primary RSA (e.g., revision RSA), lacking at least 2 years (≥21 months) of follow-up, considering concomitant tendon transfer, including RSA for severe glenoid bone loss, or using a custom glenoid. Studies including patients undergoing RSA for indications other than those specified in the inclusion criteria (post-traumatic arthritis, rheumatoid arthritis, post-infectious arthritis, revision arthroplasty, avascular necrosis, humerus malunions) were also excluded. Studies that did not report postoperative axial rotation, implant manufacturer and model, or subscapularis management were excluded. Finally, study populations of exclusively wheelchair-dependent patients were excluded. The detailed study inclusion and exclusion process is shown using a PRISMA diagram in Fig. 1. Risk of bias was assessed by a single investigator (CG) through use of the Methodological Index for Non-Randomized Studies (MINORS) criteria [12]. Individual studies and MINORS scores are indicated in Supplementary Table 1 [13-44].

Search Strategy

An experienced medical librarian (DAD) implemented a comprehensive literature search to identify English language papers on the influence of the design of RSA on axial rotation published between January 2010 and December 2019. To locate relevant studies, we queried PubMed, Embase, Scopus, the Web of Science, and the Cochrane Database of Systematic Reviews. Search terms included a combination of keywords and subject headings including “primary RSA,” “reverse shoulder arthroplasty,” “prosthetic,” “reverse shoulder replacement,” “cuff tear arthropathy,” “design,” “axial rotation,” “range of motion,” and “prosthesis” (see the Supplementary Material 1 or database-specific search strategies). In addition to limiting the results to English, they were limited to adults and the following publication types: randomized controlled trials, controlled clinical trials, clinical trials, evaluation studies, case–control studies, cohort studies, longitudinal studies, prospective studies, retrospective studies, follow-up studies, comparative studies, systematic reviews, and meta-analyses (Supplementary Material 1 for database-specific search strategies). The searches resulted in 1,071 total results. After a three-step de-duplication process in Endnote, 755 original studies remained. Exclusion criteria were applied to title and abstract screening by three authors (RJC, CG, and DAF), and, when questionable, we erred on the side of inclusion. Subsequently, full texts of the remaining articles were reviewed by the same authors. Discrepancies and uncertainties were resolved by involving the lead author (KAH); when agreement among all team members could not be reached, expert opinion was provided by a panel of senior shoulder and elbow surgeons (JJK, BSS, and JDW).

Data Extraction

Data extraction was completed by three authors (RJC, CG, and DAF) using a standardized data-collection form. Any disagreements were discussed with the lead author (KAH), and a panel of senior shoulder and elbow surgeons (JDW, JJK, TWW, BSS) was consulted to arbitrate any unresolved issues. Data extracted from the articles included in the final review included level of evidence, country of the corresponding author, whether the study was retrospective or prospective, number of shoulders, number of total patients, mean length of follow-up, average age, sex, ROM in ER, medialization vs. lateralization classification of prostheses [45], and the complications of interest. Although highly relevant, we anticipated substantial heterogeneity in the reporting of IR as described previously; thus, it was considered a secondary outcome of this study [46].

Data Analysis and Synthesis

Study characteristics were summarized descriptively. Weighted means, based on the number of RSAs in each study, were calculated for study demographics and characteristics of interest. Implant lateralization was based upon prior work by Werthel et al. [45], who reviewed digitized templates of 28 configurations with 22 different implants and assessed glenoid, humeral, and global lateralization normalized to the Delta III prosthesis (DePuy Synthes). In addition to classifying each implant into one of two glenoid categories (medialized or lateralized) and one of three humeral categories (medialized, minimally lateralized, and lateralized humerus), implants were separated into categories of 5-mm increments for global offset (medialized, minimally lateralized, lateralized, highly lateralized, and very highly lateralized). To enable meaningful comparison, the global implant lateralization of implants from included series was determined according to the method of Werthel et al. [45] and classified as medialized (medialized and minimally lateralized) or lateralized (lateralized, highly lateralized, and very highly lateralized). Studies that reported outcomes of multiple treatment strategies that we defined to be of interest for comparison a priori (i.e., prosthesis lateralization, subscapularis repair) were recorded as separate cohorts to facilitate meta-analysis. Thus, outcomes analysis was performed on 38 patient cohorts reported in 32 studies.
The weighted mean preoperative and postoperative ER values were calculated. Due to substantial heterogeneity in IR reporting, we summarized preoperative and postoperative IR values descriptively and assessed whether they achieved or exceeded the minimum necessary internal rotation (MNIR) needed to perform activities of daily living [46]. The MNIR has been previously reported to be 79° or the L3 vertebral level [7,47]. Meta-analysis was performed to compare the postoperative ER and pre- to postoperative improvement in ER based on global implant design (lateralized vs. medialized) and further stratified based on management of the subscapularis (repair with any method versus no repair). We anticipated that the design of the included studies and methodology involved in data collection would result in substantial heterogeneity; thus, we elected to use a random-effects model a priori [48]. The I2 statistic was used to assess the heterogeneity of results. The true effect size in 95% of the population (95% prediction interval) was calculated using the variance of true effects (T2) and the standard deviation of true effects (T). Meta-analysis was performed using the metafor R package [49]. All statistical analyses were performed using R (version 4.2.0; R Core Team) with an α value of 0.05.

RESULTS

Thirty-two studies reporting on 2,233 shoulders were included. The mean MINORS score was 13.4/16 points for non-comparative studies and 20.3/24 points for comparative studies. Included patients had a weighted mean age of 72.5 years (range, 66–81 years), a mean follow-up of 43 months (range, 24–97 months), a minimum follow-up of 30 months (range, 24–62 months), and 64% of patients were female. The subscapularis was repaired in 91% (n=2,032) shoulders; this did not differ based on use of a globally lateralized versus medialized implant (91% [884/967] vs. 91% [1,148/1,266], P=0.602). Mean preoperative ER was reported by 27 of the 32 included studies and had a weighted mean of 21.6° (range, 0°–45°). Mean postoperative ER was reported by all included studies and had a weighted mean of 31.2° (range, 9.9°–54°).

ER Based on Global Lateralization

The meta-analysis of postoperative ER based on global implant lateralization included 22 studies (11 lateralized cohorts, 17 medialized cohorts) reporting on 1,467 RSAs (598 lateralized, 869 medialized) (Fig. 2). According to the analysis, postoperative ER was significantly greater in cohorts with globally lateralized versus medialized implants (40° [36°–44°] vs. 27° [22°¬–32°], P<0.001). Separately, the meta-analysis of pre- to postoperative improvement in ER based on a globally lateralized versus medialized implant included 17 studies (8 lateralized cohorts, 11 medialized cohorts) reporting on 1,210 RSAs (552 lateralized, 658 medialized) (Fig. 3) and determined that pre- to postoperative improvement in ER was significantly greater in cohorts with globally lateralized versus medialized implants (20° [15°–26°] vs. 10° [5°–15°], P<0.001).

ER Based on Global Lateralization and Subscapularis Management

The meta-analysis of postoperative ER based on global implant lateralization and subscapularis repair included 22 studies (11 lateralized with subscapularis repair, 15 medialized with subscapularis repair, 2 medialized without subscapularis repair) reporting on 1,467 RSAs (598 lateralized with repair, 759 medialized with repair, 110 medialized without repair) (Fig. 4). This analysis determined that postoperative ER was significantly greater in cohorts with lateralized implants with subscapularis repair (40° [36°–44°]) or medialized implants without subscapularis repair (36° [31°–40°]) than those with globally medialized implants with subscapularis repair (26° [21°–31°], P<0.001). The meta-analysis of pre- to postoperative improvement in ER based on global implant lateralization and subscapularis repair included 17 studies (8 lateralized with subscapularis repair, 9 medialized with subscapularis repair, 2 medialized without subscapularis repair) reporting on 1,210 RSAs (552 lateralized with repair, 548 medialized with repair, 110 medialized without repair) (Fig. 5) and found that pre- to postoperative improvement in ER was significantly greater in cohorts with lateralized implants with subscapularis repair (20° [15°–26°]) or medialized implants without subscapularis repair (21° [17°–25°]) compared to those with globally medialized implants with subscapularis repair (8° [3°–13°], P<0.001).

Internal Rotation

The mean postoperative active IR was reported by 56% (n=18) of studies (9 lateralized and 12 medialized cohorts) (Table 1) [13,15-17,24,27-31,33-36,38,40,43]. The mean postoperative IR achieved the MNIR for 51% of patients with lateralized implants (n=325, 5 cohorts) versus 36% of patients with medialized implants (n=177, 5 cohorts) (P<0.001). The IR reporting methods included degrees in angle (n=4), vertebral level (n=7), and IR sub-score from the Constant score (n=6).

DISCUSSION

Lateralized RSA is hypothesized to better restore axial rotation compared to the original Grammont-style prosthesis; however, appropriately powered comparative cohort studies controlling for surgeon implant choice are impractical. The present systematic review and meta-analysis of 2,233 RSAs reported in 32 articles found that studies performing globally lateralized RSA were associated with greater preoperative to postoperative improvement in active ER and greater postoperative ER using a meta-analysis comparison. Furthermore, lateralized RSA with subscapularis repair or medialized RSA without subscapularis repair provided superior ER compared to medialized RSA with subscapularis repair. While meta-analysis of IR was not feasible, we found that a greater proportion of patients exceeded the MNIR in studies enrolling patients who underwent lateralized RSA.
Historical studies of the Grammont prosthesis reported no improvements in ER after revision TSA [4,50]. Poor restoration of ER with the Grammont prosthesis is often attributed to the medialized glenoid–medialized humerus design, which is hypothesized to inadequately tension any existing posterior rotator cuff and posterior deltoid compared to contemporary lateralized RSA designs. Although tension of the posterior cuff may be maintained through distalization of the tendon insertions with the Grammont design, their line of action becomes more oblique, effectively reducing the moment arm. Our results demonstrating superior active ER with lateralized RSA support these hypotheses and corroborate a recent meta-analysis of 440 lateralized and 425 Grammont-style RSAs, which found greater ER with use of a lateralized implant [51].
Prior meta-analyses have been conducted to compare axial ROM after lateralized versus medialized RSA [3,5,51]; however, their inclusion and exclusion criteria vary. Cho et al. [5] included five studies that compared lateralized (n=346) versus medialized (n=217) RSA and found no difference in postoperative ER (standardized mean difference, 0.21 [−0.14 to 0.56]; P=0.238); however, pre- to postoperative improvement in ER favored lateralized RSA in their analysis of two studies (standardized mean difference, 0.71 [0.36–1.07]; P<0.001). Although Cho et al. [5] similarly classified implant lateralization using the classification proposed by Werthel et al., [45], the authors only included comparative studies, limiting study inclusion. Furthermore, the authors did not specifically exclude studies with patients with preoperative diagnoses associated with poorer prognoses (i.e., post-traumatic, post-infectious, inflammatory arthritis, revision arthroplasty), severe bone loss, concomitant tendon transfer, or less than 2 years of follow-up. Berton et al. [3] performed a meta-analysis and found greater pre- to postoperative improvement in ER for lateralized (n=802, 5 studies) versus medialized (n=220, 7 studies) RSA (mean difference, 20.4° [17.6°–23.1°] vs. 8.3° [5.9°–10.7°]; P<0.01). They also found that lateralized versus medialized RSA had lower rates of scapular notching (6.6% vs. 47.7%, P<0.01) and postoperative infection (1% vs. 7.7%, P=0.01). Berton et al. [3] used stricter inclusion and exclusion criteria in their study compared to Cho et al., [5] and their work was more similar to the present study, as they included studies reporting on patients with indications limited to cuff tear arthropathy, irreparable cuff tear, or cuff tear associated with osteoarthritis. Although Berton et al. [3] also excluded studies including patients undergoing revision RSA or an indication of rheumatoid arthritis, acute fracture, post-traumatic fracture sequelae, tumor, or active infection, the authors only required 1 year of follow-up. Since ROM is known to continue to improve up to 2 years postoperatively [52], the findings of Berton et al. [3] may not accurately represent the full improvement that occurs with lateralized implants. Despite variations in inclusion and exclusion criteria, most prior meta-analyses agree that lateralized RSA provides superior ER compared to medialized RSA, with no consistent differences in clinical outcome scores across studies.
Though a few prior meta-analyses have attempted to assess the effects of both lateralization and subscapularis management, prior studies have not been able to demonstrate a difference in ER. Kim et al. [53] performed a meta-analysis of comparative studies and compared outcomes after lateralized RSA with glenoid-sided (n=257, 7 studies) versus humeral-sided (n=95, 4 studies) lateralization per Werthel et al. [45] and found no difference in ER (mean difference, 3.1°; 95% CI, −8.9° to 15.2°), forward elevation (mean difference, 1.0°; 95% CI, −13.4° to 15.5°), or ASES and Constant scores. However, a subgroup analysis of six studies involving concomitant subscapularis repair demonstrated that humeral-sided lateralization had more favorable forward elevation (mean difference, 26.1°; 95% CI, 8.5°–43.7°) but similar ER values (10.1°; 95% CI, −9.1° to 29.2°) and ASES and Constant scores compared to glenoid-sided lateralization. Corona et al. [54] performed a meta-analysis of two comparative cohort studies comparing lateralized RSA with (n=378) versus without (n=289) subscapularis repair and found no difference in postoperative ER (mean difference, −1.2°; 95% CI, −3.9° to 1.5°; P=0.39) or postoperative forward elevation (mean difference, 3.9°; 95% CI, −0.4° to 8.1°; P=0.07) but a greater postoperative IR when scored per Flurin et al. [6] (mean difference, 0.68; 95% CI, 0.46–0.89; P<0.001). In contrast, we demonstrated that use of a lateralized implant with subscapularis repair or medialized implant without subscapularis repair was associated with significantly greater postoperative ER (Fig. 4) and pre- to postoperative improvement in ER (Fig. 5) compared to using a globally medialized implant with subscapularis repair (P<0.001 for both). We believe these results suggest that tensioning of the posterior rotator cuff and deltoid with lateralization offsets the force couple of the repaired subscapularis, providing a similar ER compared to that achieved with the use of a medialized implant without subscapularis repair. Notably, the combined use of a medialized implant with subscapularis repair may provide inadequate tensioning of the external rotators to overcome the added force couple of the repaired subscapularis. However, use of a medialized implant without subscapularis repair may be unfavorable; Matthewson et al. [55] performed a meta-analysis of 1,306 patients from seven studies and recorded a greater dislocation rate when the subscapularis was not repaired (24/583 [4.1%] vs. 5/723 [0.7%], odds ratio [OR]=0.24, P=0.04). Although a trend toward a lower risk of dislocation with subscapularis repair was found when pooling studies with a lateralized RSA only, the difference was not significant (OR=0.29, P=0.07). A single study using a medialized implant found a lower dislocation rate with subscapularis repair (0.6% vs. 11%, OR=0.05, P=0.004). Unfortunately, no studies enrolling lateralized RSA patients without subscapularis repair were included in the present study. In theory, this technique may provide the greatest benefit to ER after RSA, although it has potential risk of poor active IR.
Although we were unable to perform a meta-analysis to compare IR due to heterogeneity in reporting by included studies, we found that a greater proportion of patients undergoing lateralized versus medialized RSA exceeded the MNIR (51% vs. 36%, P<0.001). The proportion of patients undergoing subscapularis repair was similar between lateralized and medialized RSA cohorts among the patients included in our study. Notably, only the study by Corona et al. [54] of all aforementioned systematic reviews attempted to meta-analyze IR and ultimately found more favorable IR (per the scale proposed by Flurin et al. [6]) with subscapularis repair versus without when a lateralized RSA was used; however, only two studies and 378 patients were included in this assessment. Together, these findings suggest that use of lateralized versus medialized RSA can provide superior ER without IR detriment, especially when the subscapularis is repaired.
This systematic review and meta-analysis is not without its limitations. Foremost, the inclusion of many retrospective studies means there are possible individual and compounded reporting biases. Additionally, the quality of our review is dictated by the quality of individual studies included. None of the studies included in the meta-analysis of ER based on both implant design and subscapularis management included patients receiving lateralized implant without subscapularis repair; biomechanically, this is believed to portend the greatest ER without sacrificing implant stability. Future studies are needed to evaluate whether lateralized RSA without subscapularis repair provides optimal ER while maintaining a low rate of postoperative instability. Although at least 2 years of clinical follow-up was required, included studies had varying follow-up periods. Furthermore, publication bias is a potential limitation (Fig. 6). The assessment of ER was not uniform: 11 studies assessed ER with the shoulder adducted at the side, one study assessed ER at 90° of abduction, and the remainder of the studies did not specify the position of the arm. We were also unable to meaningfully analyze IR due to substantial heterogeneity in reporting; this is a known limitation that has previously been reported and remains controversial [46]. Moreover, in our attempt to capture all relevant articles, we queried commonly used databases with broad search terms; however, despite these efforts, relevant articles may have been missed. Despite these limitations, this was a large-scale review and meta-analysis that contributes to the current literature and knowledge regarding the influence of prosthesis lateralization on axial rotation after RSA.

CONCLUSIONS

Lateralized RSA produces superior axial rotation compared to medialized designs. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater postoperative ER and pre- to postoperative improvement in ER compared to medialized RSA with subscapularis repair.

NOTES

Author contributions

Conceptualization: KAH, JJK, TWW, DAD, BSS, JDW. Data curation: KAH, RJC, CG, DAF, JJK, TWW, DAD, BSS, JDW. Formal analysis: KAH, JJK, TWW, BSS, JDW. Investigation: KAH, RJC, JJK, TWW, BSS, JDW. Methodology: KAH, JJK, TWW, BSS, JDW. Project administration: KAH, JJK, TWW, BSS, JDW. Resources: JJK, TWW, DAD, BSS, JDW. Supervision: KAH, RJC, JJK, TWW, BSS, JDW. Validation: KAH, JJK, TWW, BSS, JDW. Visualization: KAH, JJK, TWW, BSS, JDW. Writing – original draft: KAH, JJK. Writing – review & editing: KAH, CG, DAF, JJK, TWW, BSS, JDW.

Conflict of interest

KAH has a consultancy agreement with LinkBio Corp. JJK is a paid consultant for Exactech, Inc. and LinkBio Corp. Dr. Wright is a paid consultant and receives royalties from Exactech, Inc. BSS is a paid consultant and receives royalties from Exactech, Inc.; Responsive Arthroscopy; and Innomed. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Funding

None.

Data availability

Contact the corresponding author for data availability.

Acknowledgments

None.

SUPPLEMENTARY MATERIALS

Supplementary materials can be found via https://doi.org/10.5397/cise.2023.00577.
Supplementary Table 1.
List of included articles
cise-2023-00577-Supplementary-Table-1.pdf
Supplementary Material 1.
12.9.20 PubMed (564)
cise-2023-00577-Supplementary-Material-1.pdf

Fig. 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram depicting article identification, subsequent exclusion, and analysis for clinical outcomes and complications. RSA: reverse shoulder arthroplasty.
cise-2023-00577f1.jpg
Fig. 2.
Forest plots of the mean postoperative external rotation after reverse shoulder arthroplasty using a globally lateralized versus medialized prosthesis. SD: standard deviation, MD: mean difference, CI: confidence interval.
cise-2023-00577f2.jpg
Fig. 3.
Forest plots of the mean pre- to postoperative improvement in external rotation after reverse shoulder arthroplasty using a globally lateralized versus medialized prosthesis. SD: standard deviation, CI: confidence interval, ER: external rotation.
cise-2023-00577f3.jpg
Fig. 4.
Forest plots of the mean postoperative external rotation after reverse shoulder arthroplasty using a globally lateralized versus medialized prosthesis with versus without subscapularis repair. SD: standard deviation, MD: mean difference, CI: confidence interval.
cise-2023-00577f4.jpg
Fig. 5.
Forest plots of the mean pre- to postoperative improvement in external rotation after reverse shoulder arthroplasty using a globally lateralized versus medialized prosthesis with versus without subscapularis repair. SD: standard deviation, CI: confidence interval, ER: external rotation.
cise-2023-00577f5.jpg
Fig. 6.
Funnel plot assessing the presence of publication bias in the 17 studies included in the analysis of mean pre- to postoperative improvement in external rotation (Figs. 3 and 5). The result of Egger’s test for asymmetry was significant (P=0.004).
cise-2023-00577f6.jpg
Table 1.
Studies reporting mean postoperative internal rotation after reverse shoulder arthroplasty using a globally lateralized versus medialized prosthesis design
Study Subscapularis management N Mean postoperative IR (vertebral level, IR Constant score, or °) Achieved MNIR* Glenohumeral construct
Globally lateralized
 Boutsiadis et al. (2018) [15] Repaired (tenotomy) 10 L3 Yes MGLH+
 Boutsiadis et al. (2018) [15] Repaired (tenotomy) 12 L3 Yes LGLH+
 Franceschetti et al. (2020) [24] Repaired 59 4.6 No MGLH+
 King et al. (2015) [29] Not repaired 83 L2 Yes MGLH+
 Katz et al. (2016) [27] Not repaired 140 6.6 Yes LGLH+
 Merolla et al. (2018) [30] Repaired (tenotomy) 38 4.7 No MGLH+
 Oh et al. (2020) [35] Not repaired 80 T10 Yes LGLH+
 Steen et al. (2015) [40] Repaired 24 L4–L5 No LGMH
 Walters et al. (2020) [43] Not repaired 186 51° No LGLH+
Globally medialized
 Athwal et al. (2016) [13] Repaired (peel) 24 SI No MGMH
 Boutsiadis et al. (2018) [15] Repaired (tenotomy) 13 L3 Yes MGMH
 Boutsiadis et al. (2018) [15] Repaired (tenotomy) 11 L3 Yes LGMH
 Castricini et al. (2013) [16] Not repaired 80 64° No MGMH
 Collin et al. (2019) [17] Repaired (tenotomy) 49 6.5 Yes MGMH
 Kim et al. (2020) [28] Repaired (peel) & not repaired 77 L3 Yes MGMH
 Merolla et al. (2018) [30] Repaired (LTO) 36 4.7 No MGMH
 Mizuno et al. (2013) [31] Repaired (tenotomy) 27 T12 Yes MGMH
 Morris et al. (2015) [33] Not repaired 43 5.1 No MGMH
 Müller et al. (2018) [34] Repaired (tenotomy) 66 35.9° No MGMH
 Ortmaier et al. (2016) [36] Not repaired 8 2.5 No MGMH/MGLH
 Rhee et al. (2015) [38] Repaired (peel) 62 46.8° No MGMH

IR: internal rotation, MNIR: minimum necessary internal rotation, MG: medialized glenoid, LH: lateralized humerus, LG: lateralized glenoid, MH: medialized humerus, SI: sacroiliac joint, LTO: lesser tuberosity osteotomy.

* MNIR as defined by Gates et al. [47] as 79° and by Rol et al. [7] as L3 vertebral level;

Constant score: 0, lateral thigh; 2, Buttock; 4, lumbosacral junction; 6, waist (L3); 8, T12 vertebra; 10, Interscapular (T7).

REFERENCES

1. Grammont P, trouilloud P, Laffay JP, Deries X. Etude et réalisation d’une nouvelle prothèse d’épaule. Rhumatologie 1987;39:407–18.

2. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 1993;16:65–8.
crossref pmid
3. Berton A, Gulotta LV, Longo UG, et al. Medialized versus lateralized center of rotation in reverse total shoulder arthroplasty: a systematic review and meta-analysis. J Clin Med 2021;10:5868.
pmid pmc
4. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 2005;14(1 Suppl S):147S–161S.
crossref pmid
5. Cho SH, Lee HJ, Aldhafian OR, Kim YS. Comparison of lateralized versus medialized reverse total shoulder arthroplasty: a systematic review and meta-analysis. Orthop J Sports Med 2022;10:23259671211063922.
pmid pmc
6. Flurin PH, Marczuk Y, Janout M, Wright TW, Zuckerman J, Roche CP. Comparison of outcomes using anatomic and reverse total shoulder arthroplasty. Bull Hosp Jt Dis (2013) 2013;71 Suppl 2:101–7.
pmid
7. Rol M, Favard L, Berhouet J, la Société d’orthopédie de l’Ouest (SOO). Factors associated with internal rotation outcomes after reverse shoulder arthroplasty. Orthop Traumatol Surg Res 2019;105:1515–9.
pmid
8. Bigdon SF, Bolliger L, Albers CE, Collin P, Zumstein MA. Subscapularis in reverse total shoulder arthroplasty. J Shoulder Elb Arthroplast 2019;3:2471549219834192.
crossref
9. De Fine M, Sartori M, Giavaresi G, et al. The role of subscapularis repair following reverse shoulder arthroplasty: systematic review and meta-analysis. Arch Orthop Trauma Surg 2022;142:2147–56.
pmid
10. Jawa A, Colliton EM. Role of subscapularis tendon repair in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 2021;29:604–8.
crossref pmid
11. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535.

12. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003;73:712–6.
crossref pmid
13. Athwal GS, Faber KJ. Outcomes of reverse shoulder arthroplasty using a mini 25-mm glenoid baseplate. Int Orthop 2016;40:109–13.

14. Ballas R, Béguin L. Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening. J Shoulder Elbow Surg 2013;22:e1–6.
crossref
15. Boutsiadis A, Lenoir H, Denard PJ, et al. The lateralization and distalization shoulder angles are important determinants of clinical outcomes in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2018;27:1226–34.
pmid
16. Castricini R, Gasparini G, Di Luggo F, De Benedetto M, De Gori M, Galasso O. Health-related quality of life and functionality after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2013;22:1639–49.
crossref pmid
17. Collin P, Hervé A, Walch G, Boileau P, Muniandy M, Chelli M. Mid-term results of reverse shoulder arthroplasty for glenohumeral osteoarthritis with posterior glenoid deficiency and humeral subluxation. J Shoulder Elbow Surg 2019;28:2023–30.

18. Collin P, Matsukawa T, Denard PJ, Gain S, Lädermann A. Pre-operative factors influence the recovery of range of motion following reverse shoulder arthroplasty. Int Orthop 2017;41:2135–42.
crossref pmid
19. Cuff DJ, Santoni BG. Reverse shoulder arthroplasty in the weight-bearing versus non-weight-bearing shoulder: mid-term outcomes with minimum 5-year follow-up. Orthopedics 2018;41:e328–33.
pmid
20. Cuff DJ, Santoni BG. Anatomic total shoulder arthroplasty versus reverse total shoulder arthroplasty for post-capsulorrhaphy arthropathy. Orthopedics 2018;41:275–80.
crossref pmid
21. De Biase CF, Delcogliano M, Borroni M, Castagna A. Reverse total shoulder arthroplasty: radiological and clinical result using an eccentric glenosphere. Musculoskelet Surg 2012;96 Suppl 1:S27–34.
pmid
22. Dukan R, Bahman M, Rousseau MA, Boyer P. Outcomes of reverse shoulder arthroplasty using a short stem through a superolateral approach. J Shoulder Elbow Surg 2020;29:1197–205.
crossref pmid
23. Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time. Clin Orthop Relat Res 2011;469:2469–75.

24. Franceschetti E, Ranieri R, Giovanetti de Sanctis E, Palumbo A, Franceschi F. Clinical results of bony increased-offset reverse shoulder arthroplasty (BIO-RSA) associated with an onlay 145° curved stem in patients with cuff tear arthropathy: a comparative study. J Shoulder Elbow Surg 2020;29:58–67.
crossref
25. Garofalo R, Flanagin B, Castagna A, Calvisi V, Krishnan SG. Massive irreparable rotator cuff tear and associated deltoid tear: does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment. J Orthop Sci 2016;21:753–8.
pmid
26. Gobezie R, Shishani Y, Lederman E, Denard PJ. Can a functional difference be detected in reverse arthroplasty with 135° versus 155° prosthesis for the treatment of rotator cuff arthropathy: a prospective randomized study. J Shoulder Elbow Surg 2019;28:813–8.
crossref pmid
27. Katz D, Valenti P, Kany J, Elkholti K, Werthel JD. Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching?: clinical and radiological review of one hundred and forty cases with forty five months of follow-up. Int Orthop 2016;40:99–108.

28. Kim MS, Jeong HY, Kim JD, Ro KH, Rhee SM, Rhee YG. Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2020;29:86–94.
crossref pmid
29. King JJ, Farmer KW, Struk AM, Wright TW. Uncemented versus cemented humeral stem fixation in reverse shoulder arthroplasty. Int Orthop 2015;39:291–8.

30. Merolla G, Walch G, Ascione F, et al. Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up. J Shoulder Elbow Surg 2018;27:701–10.
crossref
31. Mizuno N, Denard PJ, Raiss P, Walch G. Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am 2013;95:1297–304.
pmid
32. Morris BJ, Haigler RE, Cochran JM, et al. Obesity has minimal impact on short-term functional scores after reverse shoulder arthroplasty for rotator cuff tear arthropathy. Am J Orthop (Belle Mead NJ) 2016;45:E180–6.

33. Morris BJ, Haigler RE, O'Connor DP, Elkousy HA, Gartsman GM, Edwards TB. Outcomes of staged bilateral reverse shoulder arthroplasties for rotator cuff tear arthropathy. J Shoulder Elbow Surg 2015;24:474–81.
pmid
34. Müller AM, Born M, Jung C, et al. Glenosphere size in reverse shoulder arthroplasty: is larger better for external rotation and abduction strength. J Shoulder Elbow Surg 2018;27:44–52.
crossref
35. Oh JH, Sharma N, Rhee SM, Park JH. Do individualized humeral retroversion and subscapularis repair affect the clinical outcomes of reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2020;29:821–9.
pmid
36. Ortmaier R, Plachel F, Lederer S, et al. Reverse shoulder arthroplasty after failed pectoralis major tendon transfer with a minimum follow-up of 5 years: a case series. J Orthop Sci 2016;21:591–5.
crossref
37. Poon PC, Chou J, Young SW, Astley T. A comparison of concentric and eccentric glenospheres in reverse shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2014;96:e138
pmid
38. Rhee YG, Cho NS, Moon SC. Effects of humeral component retroversion on functional outcomes in reverse total shoulder arthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg 2015;24:1574–81.
crossref
39. Sadoghi P, Vavken P, Leithner A, et al. Impact of previous rotator cuff repair on the outcome of reverse shoulder arthroplasty. J Shoulder Elbow Surg 2011;20:1138–46.

40. Steen BM, Cabezas AF, Santoni BG, et al. Outcome and value of reverse shoulder arthroplasty for treatment of glenohumeral osteoarthritis: a matched cohort. J Shoulder Elbow Surg 2015;24:1433–41.
crossref
41. Teissier P, Teissier J, Kouyoumdjian P, Asencio G. The TESS reverse shoulder arthroplasty without a stem in the treatment of cuff-deficient shoulder conditions: clinical and radiographic results. J Shoulder Elbow Surg 2015;24:45–51.

42. Theivendran K, Varghese M, Large R, et al. Reverse total shoulder arthroplasty using a trabecular metal glenoid base plate: functional and radiological outcomes at two to five years. Bone Joint J 2016;98-B:969–75.
pmid
43. Walters JD, George LW 2nd, Walsh RN, et al. The effect of current and former tobacco use on outcomes after primary reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2020;29:244–51.

44. Wiater JM, Moravek JE Jr, Budge MD, Koueiter DM, Marcantonio D, Wiater BP. Clinical and radiographic results of cementless reverse total shoulder arthroplasty: a comparative study with 2 to 5 years of follow-up. J Shoulder Elbow Surg 2014;23:1208–14.
crossref pmid
45. Werthel JD, Walch G, Vegehan E, Deransart P, Sanchez-Sotelo J, Valenti P. Lateralization in reverse shoulder arthroplasty: a descriptive analysis of different implants in current practice. Int Orthop 2019;43:2349–60.

46. Rojas J, Joseph J, Srikumaran U, McFarland EG. How internal rotation is measured in reverse total shoulder arthroplasty: a systematic review of the literature. JSES Int 2019;4:182–8.
crossref
47. Gates DH, Walters LS, Cowley J, Wilken JM, Resnik L. Range of motion requirements for upper-limb activities of daily living. Am J Occup Ther 2016;70:7001350010p1–7001350010p10.

48. Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 2010;1:97–111.
crossref
49. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw 2010;36:1–48.

50. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff: results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 2004;86:388–95.

51. Nunes B, Linhares D, Costa F, Neves N, Claro R, Silva MR. Lateralized versus nonlateralized glenospheres in reverse shoulder arthroplasty: a systematic review with meta-analysis. J Shoulder Elbow Surg 2021;30:1700–13.
pmid
52. Simovitch RW, Friedman RJ, Cheung EV, et al. Rate of improvement in clinical outcomes with anatomic and reverse total shoulder arthroplasty. J Bone Joint Surg Am 2017;99:1801–11.
crossref
53. Kim H, Ma SB, Lee KW, Koh KH. Which lateralization designed prosthesis of reverse total shoulder arthroplasty (glenoid-based lateralization vs humerus-based lateralization) would be better?: network Meta-analysis. J Orthop Surg (Hong Kong) 2022;30:10225536221122307.

54. Corona K, Cerciello S, Ciolli G, et al. Clinical outcomes and joint stability after lateralized reverse total shoulder arthroplasty with and without subscapularis repair: a meta-analysis. J Clin Med 2021;10:3014.
crossref
55. Matthewson G, Kooner S, Kwapisz A, Leiter J, Old J, MacDonald P. The effect of subscapularis repair on dislocation rates in reverse shoulder arthroplasty: a meta-analysis and systematic review. J Shoulder Elbow Surg 2019;28:989–97.



ABOUT
ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES
EDITORIAL POLICY
FOR CONTRIBUTORS
Editorial Office
#6603, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
E-mail: journal@cisejournal.org                

Copyright © 2024 by Korean Shoulder and Elbow Society.

Developed in M2PI

Close layer
prev next