International Orthopaedics

, Volume 41, Issue 10, pp 2135–2142 | Cite as

Pre-operative factors influence the recovery of range of motion following reverse shoulder arthroplasty

  • Philippe Collin
  • Tetsuya Matsukawa
  • Patrick J. Denard
  • Solenn Gain
  • Alexandre LädermannEmail author
Original Paper



Recently the use of reverse shoulder arthroplasty (RSA) has increased because of a clinical perception of durable functional outcome. However, some patients unexpectedly have a poor recovery of range of motion (ROM) after surgery. Objective factors such as initial diagnosis, pre- and intra-operative ROM, deltoid impairment or arm lengthening have previously been associated with anterior forward flexion (AFF). This study sought to determine if subjective pre-operative factors influence the rate and timing of ROM recovery after RSA.


Between January 2011 to January 2012, all RSAs performed by a single surgeon were prospectively enrolled in this study. The cohort was divided into two groups based on AFF <90 or ≥90 after surgery. A multivariate analysis was performed to define independent predictive factors of post-operative ROM. Factors assessed included: age, sex, dominant arm, patient activity, body mass index (BMI), pre-operative diagnosis, deltoid status, pain and Constant scores, subjective shoulder value (SSV), simple shoulder test (SST) and radiographic findings. Patients were reviewed at six weeks, and three, six, 12 and 24 months.


One hundred and one RSAs were available for analysis. Poor post-operative AFF at six weeks was significantly related to poor pre-operative deltoid strength. Poor post-operative AFF at one-year follow-up was related to surgery of non-dominant arm, pre-operative poor AFF, pre-operative activity, poor subjective shoulder value (SSV), and a low contralateral Constant score. AFF and Constant score improved until six months and then plateaued. In contrast, both external and internal rotation continued to improve beyond six months after surgery.


AFF and Constant scores after RSA plateau at six months after surgery whereas internal and external rotation continue to improve up to two years post operation. Several pre-operative factors including poor pre-operative AFF, surgery on the non-dominant arm, and lower SSV and Constant scores are correlated with post-operative ROM following RSA. Identification of these factors may be useful for counseling on functional expectations as well as customizing rehabilitation plans.

Level of Evidence: Level II, Prospective Cohort Study, Treatment Study


Shoulder prosthesis Reverse shoulder arthroplasty Range of motion Active forward flexion Predicting factors Results Postoperative function 


Compliance with ethical standards

Conflict of interest

PC is a paid consultant from Wright and Smith and Nephew and received royalties from Wright, Storz and Advanced Medical Application.

PJD is a consultant for and receives royalties from Arthrex BLINDED FOR PURPOSE REVIEW.

The other authors certify that they or any members of their immediate families, have no funding or commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical committee approval



  1. 1.
    Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89:1476–1485. doi: 10.2106/JBJS.F.00666 PubMedGoogle Scholar
  2. 2.
    Hartzler RU, Steen BM, Hussey MM, Cusick MC, Cottrell BJ, Clark RE, Frankle MA (2015) Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement. J Shoulder Elb Surg 24:1698–1706. doi: 10.1016/j.jse.2015.04.015 CrossRefGoogle Scholar
  3. 3.
    Schwartz DG, Cottrell BJ, Teusink MJ, Clark RE, Downes KL, Tannenbaum RS, Frankle MA (2014) Factors that predict postoperative motion in patients treated with reverse shoulder arthroplasty. J Shoulder Elb Surg 23:1289–1295. doi: 10.1016/j.jse.2013.12.032 CrossRefGoogle Scholar
  4. 4.
    Walch G, Bacle G, Lädermann A, Nove-Josserand L, Smithers CJ (2012) Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon’s experience? J Shoulder Elb Surg 21:1470–1477. doi: 10.1016/j.jse.2011.11.010 CrossRefGoogle Scholar
  5. 5.
    Cuff D, Pupello D, Virani N, Levy J, Frankle M (2008) Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 90:1244–1251. doi: 10.2106/JBJS.G.00775 CrossRefPubMedGoogle Scholar
  6. 6.
    Lädermann A, Walch G, Denard PJ, Collin P, Sirveaux F, Favard L, Edwards TB, Kherad O, Boileau P (2013) Reverse shoulder arthroplasty in patients with pre-operative impairment of the deltoid muscle. Bone Joint J 95-B:1106–1113. doi: 10.1302/0301-620X.95B8.31173 CrossRefPubMedGoogle Scholar
  7. 7.
    Lädermann A, Edwards TB, Walch G (2014) Arm lengthening after reverse shoulder arthroplasty: a review. Int Orthop 38:991–1000. doi: 10.1007/s00264-013-2175-z CrossRefPubMedGoogle Scholar
  8. 8.
    Lädermann A, Walch G, Lubbeke A, Drake GN, Mélis B, Bacle G, Collin P, Edwards TB, Sirveaux F (2012) Influence of arm lengthening in reverse shoulder arthroplasty. J Shoulder Elb Surg 21:336–341. doi: 10.1016/j.jse.2011.04.020 CrossRefGoogle Scholar
  9. 9.
    Lädermann A, Williams MD, Mélis B, Hoffmeyer P, Walch G (2009) Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elb Surg 18:588–595. doi: 10.1016/j.jse.2009.03.012 CrossRefGoogle Scholar
  10. 10.
    Lädermann A, Lubbeke A, Melis B, Stern R, Christofilopoulos P, Bacle G, Walch G (2011) Prevalence of neurologic lesions after total shoulder arthroplasty. J Bone Joint Surg Am 93:1288–1293. doi: 10.2106/JBJS.J.00369 CrossRefPubMedGoogle Scholar
  11. 11.
    Walch G, Wall B (2006) Indication and techniques of revision arthroplasty with a reverse prosthesis. In: Walch G, Boileau P, Mole D, Favard L, Lévigne C, Sirveaux F (eds) Reverse shoulder arthroplasty. Sauramps Medical, Montpellier, France, pp 243–246Google Scholar
  12. 12.
    Berhouet J, Garaud P, Favard L (2013) Evaluation of the role of glenosphere design and humeral component retroversion in avoiding scapular notching during reverse shoulder arthroplasty. J Shoulder Elb Surg 23(2):151–158. doi: 10.1016/j.jse.2013.05.009
  13. 13.
    Gulotta LV, Choi D, Marinello P, Knutson Z, Lipman J, Wright T, Cordasco FA, Craig EV, Warren RF (2012) Humeral component retroversion in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elb Surg 21:1121–1127. doi: 10.1016/j.jse.2011.07.027 CrossRefGoogle Scholar
  14. 14.
    Stephenson DR, Oh JH, McGarry MH, Rick Hatch GF III, Lee TQ (2011) Effect of humeral component version on impingement in reverse total shoulder arthroplasty. J Shoulder Elb Surg 20:652–658. doi: 10.1016/j.jse.2010.08.020 CrossRefGoogle Scholar
  15. 15.
    Liotard J (2010) Painful shoulder rehabilitation: how to do it simple. Revue du Rhumatisme Monographies 77:239–245Google Scholar
  16. 16.
    Saha AK (1958) Zero position of the glenohumeral joint: its recognition and clinical importance. Ann R Coll Surg Engl 22:223–226PubMedPubMedCentralGoogle Scholar
  17. 17.
    Medical Research Council (1943) Aids to the investigation of peripheral nerve injuries. Medical Research Council war memorandum. His Majesty’s Stationery Office, London, EnglandGoogle Scholar
  18. 18.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
  19. 19.
    Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Shoulder Elb Surg 16:717–721. doi: 10.1016/j.jse.2007.02.123 CrossRefGoogle Scholar
  20. 20.
    Lippitt S, Harryman DTI, Matsen FAI (1993) A pratical tool for function evaluation: the «simple shoulder test». In: FAI M, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy Of Orthopaedic Surgeons, Rosemont Illinois, pp 501–518Google Scholar
  21. 21.
    Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 254:92–96Google Scholar
  22. 22.
    Walch G, Badet R, Boulahia A, Khoury A (1999) Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplast 14:756–760CrossRefGoogle Scholar
  23. 23.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8:599–605CrossRefGoogle Scholar
  24. 24.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83Google Scholar
  25. 25.
    Mizuno N, Denard PJ, Raiss P, Walch G (2013) Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am 95:1297–1304. doi: 10.2106/JBJS.L.00820 CrossRefPubMedGoogle Scholar
  26. 26.
    Haller S, Cunningham G, Lädermann A, Hofmeister J, Van De Ville D, Lovblad KO, Hoffmeyer P (2014) Shoulder apprehension impacts large-scale functional brain networks. AJNR Am J Neuroradiol 35:691–697. doi: 10.3174/ajnr.A3738 CrossRefPubMedGoogle Scholar
  27. 27.
    Zanchi D, Cunningham G, Lädermann A, Ozturk M, Hoffmeyer P, Haller S (2017) Structural white matter and functional connectivity alterations in patients with shoulder apprehension. Sci Rep 7:42327. doi: 10.1038/srep42327 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Zanchi D, Cunningham G, Lädermann A, Ozturk M, Hoffmeyer P, Haller S (2017) Brain activity in the right-frontal pole and lateral occipital cortex predicts successful post-operatory outcome after surgery for anterior glenoumeral instability. Sci Rep. 7:498. doi:  10.1038/s41598-017-00518-9
  29. 29.
    Hauert C, Deiber M, Thut G (2002) La coordination motrice interhémisphérique. Rev Neuropsychol 12:241–274Google Scholar
  30. 30.
    Collin P, Gain S, Nguyen Huu F, Lädermann A (2015) Predicting factors of recovering active forward flexion after reverse shoulder Arthroplasty. Swiss Med Wkly 144:34SGoogle Scholar
  31. 31.
    Puskas B, Harreld K, Clark R, Downes K, Virani NA, Frankle M (2013) Isometric strength, range of motion, and impairment before and after total and reverse shoulder arthroplasty. J Shoulder Elb Surg 22(7):869–876. doi: 10.1016/j.jse.2012.09.004
  32. 32.
    Wirth B, Kolling C, Schwyzer HK, Flury M, Audige L (2016) Risk of insufficient internal rotation after bilateral reverse shoulder arthroplasty: clinical and patient-reported outcome in 57 patients. J Shoulder Elb Surg 25:1146–1154. doi: 10.1016/j.jse.2015.11.010 CrossRefGoogle Scholar
  33. 33.
    Lädermann A, Denard PJ, Boileau P, Farron A, Deransart P, Terrier A, Ston J, Walch G (2015) Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty. Int Orthop 39:2205–2213. doi: 10.1007/s00264-015-2984-3 CrossRefPubMedGoogle Scholar
  34. 34.
    Lädermann A, Gueorguiev B, Charbonnier C, Stimec BV, Fasel JH, Zderic I, Hagen J, Walch G (2015) Scapular notching on kinematic simulated range of motion after reverse shoulder Arthroplasty is not the result of impingement in adduction. Medicine (Baltimore) 94:e1615. doi: 10.1097/MD.0000000000001615 CrossRefGoogle Scholar
  35. 35.
    Jobin CM, Brown GD, Bahu MJ, Gardner TR, Bigliani LU, Levine WN, Ahmad CS (2012) Reverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization. J Shoulder Elb Surg 21:1269–1277. doi: 10.1016/j.jse.2011.08.049 CrossRefGoogle Scholar
  36. 36.
    Renaud P, Wahab H, Bontoux L, Dauty M, Richard I, Bregeon C (2001) Total inverted shoulder prosthesis and rotator cuff insufficiency: evaluation and determination of anatomical parameters predictive of good functional outcome in 21 shoulders. Ann Readapt Med Phys 44:273–280CrossRefPubMedGoogle Scholar
  37. 37.
    Mélis B, DeFranco M, Lädermann A, Mole D, Favard L, Nerot C, Maynou C, Walch G (2011) An evaluation of the radiological changes around the Grammont reverse geometry shoulder arthroplasty after eight to 12 years. J Bone Joint Surg Br 93:1240–1246. doi: 10.1302/0301-620X.93B9.25926 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Centre Hospitalier Privé Saint-Grégoire (Vivalto santé)Saint-Grégoire CedexFrance
  2. 2.Department of Orthopaedic SurgeryNagoya University School of MedicineNagoyaJapan
  3. 3.Southern Oregon OrthopedicsMedfordUSA
  4. 4.Department of Orthopaedics and RehabilitationOregon Health & Science UniversityPortlandUSA
  5. 5.Division of Orthopaedics and Trauma SurgeryLa Tour HospitalMeyrinSwitzerland
  6. 6.Faculty of MedicineUniversity of GenevaGeneva 4Switzerland
  7. 7.Division of Orthopaedics and Trauma Surgery, Department of SurgeryGeneva University HospitalsGeneva 14Switzerland

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