Assessment of anatomical and reverse total shoulder arthroplasty with the scapula-weighted Constant-Murley score
Aim of the study
To evaluate total (TSA) and reverse total shoulder arthroplasty (RTSA) using the Constant-Murley score (CMS) and the scapula-weighted (SW) CMS, an integrated outcome measure that takes into account the compensatory movements of the scapula.
Twenty-five consecutive patients, 12 with TSA and 13 with RTSA, underwent kinematic analysis before and after shoulder replacement. Measurements included flexion (FLEX) and abduction (ABD) for the humerus and Protraction-Retraction (PR-RE), Medio-Lateral rotation (ME-LA), and Posterior-Anterior tilting (P-A) for the scapula. They were recorded at baseline (T0) and at six (T1) and 12 months (T2). Reference data were obtained from 31 control shoulders.
At T1, differences in CMS and SW-CMS were not significant in either group, whereas values at T2 were significantly lower in RTSA patients (p = 0.310 and p = 0.327, respectively). In TSA shoulders, the compensatory scapular movements in FLEX were all reduced from T0 to T2, whereas P-A was increased in ABD. In RTSA patients, the compensatory scapular movements in FLEX showed a general reduction at T1, with an increase in P-A at T2, whereas in ABD, all increased at T1 and decreased at T2 except for P-A, which did not decrease.
The SW-CMS showed that the physiological scapulothoracic motion was not restored in TSA and RTSA patients; it may be used as a reference for the gradual progression of deltoid and scapular muscle rehabilitation.
The worse CMS and SW-CMS scores found in RTSA patients at six months may be due to the biomechanics of the reverse prosthesis and to the weakness of deltoid and periscapular muscles.
KeywordsShoulder osteoarthritis Total arthroplasty Reverse Kinematic analysis Constant-Murley score Scapular dyskines
Compliance with ethical standards
IRB approval was obtained from the institutional review board of the Coordinator Center in Cattolica, Italy (Prot. No. 5494/2012 I.5/197 CEAV/IRST Meldola, Italy).
- 2.Sowa B, Bochenek M, Bülhoff M, Zeifang F, Loew M, Bruckner T et al (2017) The medium- and long-term outcome of total shoulder arthroplasty for primary glenohumeral osteoarthritis in middle-aged patients. Bone Joint J 99-B:939–943. https://doi.org/10.1302/0301-620X.99B7.BJJ-2016-1365.R1 CrossRefPubMedGoogle Scholar
- 3.Merolla G, Cerciello S, Marenco S, Fabbri E, Paladini P, Porcellini G (2018) Comparison of shoulder replacement to treat osteoarthritis secondary to instability surgery and primary osteoarthritis: a retrospective controlled study of patient outcomes. Int Orthop 2018. doi: https://doi.org/10.1007/s00264-018-3969-9
- 7.Sevivas N, Ferreira N, Andrade R, Moreira P, Portugal R, Alves D et al (2017) Reverse shoulder arthroplasty for irreparable massive rotator cuff tear: a systematic review with meta-analysis and meta-regression. J Shoulder Elbow Surg 26:e265–e277. https://doi.org/10.1016/j.jse.2017.03.039 CrossRefPubMedGoogle Scholar
- 8.Zilber S, Camana E, Lapner P, Haritinian E, Nove Josserand L (2018, 2018) Reverse total shoulder arthroplasty using helical blade to optimize glenoid fixation and bone preservation: preliminary results in thirty five patients with minimum two year follow-up. Int Orthop. https://doi.org/10.1007/s00264-018-3891-1
- 10.Lo IKY, Litchfield RB, Griffin S, Faber K, Patterson SDKA (2005) Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. a prospective randomized trial. J Bone Joint Surg Am 87-A:2178–2185Google Scholar
- 12.Angst F, Schwyzer HS, Aeschlimann A, Simmen BRGJ (2011) Measures of adult shoulder function Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Its Short Version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society Standardized Shoulder A. Arthritis Care Res 63:S174–S188. https://doi.org/10.1002/acr.20630 CrossRefGoogle Scholar
- 16.Kasten P, Maier M, Wendy P, Rettig O, Raiss P, Wolf S et al (2010) Can shoulder arthroplasty restore the range of motion in activities of daily living? A prospective 3D video motion analysis study. J Shoulder Elbow Surg 19:59–65. https://doi.org/10.1016/j.jse.2009.10.012 CrossRefPubMedGoogle Scholar
- 18.Maier MW, Caspers M, Zeifang F, Dreher T, Klotz MC, Wolf SI et al (2014) How does reverse shoulder replacement change the range of motion in activities of daily living in patients with cuff tear arthropathy? A prospective optical 3D motion analysis study. Arch Orthop Trauma Surg 134:1065–1071. https://doi.org/10.1007/s00402-014-2015-7 CrossRefPubMedGoogle Scholar
- 19.Maier MW, Niklasch M, Dreher T, Zeifang F, Rettig O, Klotz MC et al (2014) Motion patterns in activities of daily living: 3-year longitudinal follow-up after total shoulder arthroplasty using an optical 3D motion analysis system. BMC Musculoskeletal Disorders 15:244. https://doi.org/10.1186/1471-2474-15-244 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Toledo D, Loss JF, Janssen TW, van der Scheer JW, Alta TD, Willmes WJ et al (2012) Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads. Clin Biomech 21:S39–S44Google Scholar
- 23.Cutti AG, Parel I, Pellegrini A, Paladini P, Sacchetti R, Porcellini G et al (2016) The Constant score and the assessment of scapula dyskinesis: Proposal and assessment of an integrated outcome measure. J Electromyogr Kinesiol 29:81–89. https://doi.org/10.1016/j.jelekin.2015.06.011 CrossRefPubMedGoogle Scholar
- 26.Favard L, Lautmann S, Sirveaux F, Oudet D, Kerjean Y (2001) Hemiarthroplasty versus reverse arthroplasty in the treatment of osteoarthritis with massive rotator cuff tear. In: Walch G, Boileau P, Mole´ D, eds. 2000 Shoulder Prostheses. Two to yen years follow-up. Paris: Sauramps Medical; :261–268Google Scholar
- 28.Merolla G, Ciaramella G, Fabbri E, Walch G, Paladini P, Porcellini G (2016) Total shoulder replacement using a bone ingrowth central peg polyethylene glenoid component: a prospective clinical and computed tomography study with short- to mid-term follow-up. Int Orthop 40:2355–2363. https://doi.org/10.1007/s00264-016-3255-7 CrossRefPubMedGoogle Scholar