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Degenerative changes of the deltoid muscle have impact on clinical outcome after reversed total shoulder arthroplasty

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Despite a high complication rate, subjective and objective results of reversed shoulder arthroplasty for severe rotator cuff lesions associated with osteoarthritis, fracture sequelae, or revision of hemiarthroplasty are favorable. However, whether the changes in biomechanics of the joint may lead to structural changes in the remaining rotator cuff and the deltoid muscle, and may thereby alter the clinical result, has rarely been described. This study investigates the context between postoperative fatty infiltration of the remaining rotator cuff and the deltoid muscle, and the clinical outcome after reversed shoulder arthroplasty.

Methods

Twenty-three patients with an average age of 73.1 ± 5.6 years were evaluated at an average of 26 ± 16.8 months. Evaluation included assessment of Constant Score, disabilities of the arm, shoulder and hand score, radiographic evaluation with measurement of the humeral lengthening and medialization of the center of rotation, and magnetic resonance imaging or computed tomography to classify changes in the rotator cuff and the deltoid muscle.

Results

There was a significant correlation between fatty infiltration of the deltoid muscle and the clinical score results. Patients with a longer follow-up showed a higher amount of degenerative changes of the deltoid than patients with a shorter follow-up. Degenerative changes of the rotator cuff showed no significant correlation to clinical results. The amount of arm lengthening, medialization of the center of rotation, and scapula notching showed no correlation to clinical results or degenerative changes of the deltoid and the rotator cuff.

Conclusions

These data show that degeneration of the deltoid muscle is of impact for clinical outcome. Although other factors like disuse or pain as a reason for muscular changes cannot be fully excluded, this degeneration might occur after time due to biomechanical changes after reversed arthroplasty. However, prospective studies with longer follow-up periods and repetitive assessment of muscle quality are necessary to further support these results.

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References

  1. Arntz CT, Jackins S, Matsen FA III (1993) Prosthetic replacement of the shoulder for the treatment of defects in the rotator cuff and the surface of the glenohumeral joint. J Bone Joint Surg Am 75:485–491

    CAS  PubMed  Google Scholar 

  2. Ashry R, Schweitzer ME, Cunningham P, Cohen J, Babb J, Cantos A (2007) Muscle atrophy as a consequence of rotator cuff tears: should we compare the muscles of the rotator cuff with those of the deltoid? Skeletal Radiol 36:841–845

    Article  PubMed  Google Scholar 

  3. Bastard JP, Maachi M, Lagathu C et al (2006) Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 17:4–12

    CAS  PubMed  Google Scholar 

  4. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15:527–540

    Article  PubMed  Google Scholar 

  5. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 14:147S–161S

    Article  PubMed  Google Scholar 

  6. Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 89:516–520

    Article  CAS  PubMed  Google Scholar 

  7. Burkhart SS (1991) Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale. Clin Orthop Relat Res 267:45–56

    PubMed  Google Scholar 

  8. Burkhart SS (2001) Arthroscopic treatment of massive rotator cuff tears. Clin Orthop Relat Res 390:107–118

    Article  PubMed  Google Scholar 

  9. Cofield RH (1985) Shoulder arthrodesis and resection arthroplasty. Instr Course Lect 34:268–277

    CAS  PubMed  Google Scholar 

  10. Cofield RH, Briggs BT (1979) Glenohumeral arthrodesis. Operative and long-term functional results. J Bone Joint Surg Am 61:668–677

    CAS  PubMed  Google Scholar 

  11. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Franklin JL, Barrett WP, Jackins SE, Matsen FA III (1988) Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplasty 3:39–46

    Article  CAS  PubMed  Google Scholar 

  14. 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 Elbow Surg 8:599–605

    Article  CAS  PubMed  Google Scholar 

  15. Germann G, Harth A, Wind G, Demir E (2003) Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) questionnaire. Unfallchirurg 106:13–19

    Article  CAS  PubMed  Google Scholar 

  16. Germann G, Wind G, Harth A (1999) The DASH (Disability of Arm-Shoulder-Hand) Questionnaire—a new instrument for evaluating upper extremity treatment outcome. Handchir Mikrochir Plast Chir 31:149–152

    Article  CAS  PubMed  Google Scholar 

  17. Gohlke F, Rolf O (2007) Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the transhumeral approach: method incorporating a pectoralis-major-pedicled bone window. Oper Orthop Traumatol 19:185–208

    Article  PubMed  Google Scholar 

  18. 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 304:78–83

    PubMed  Google Scholar 

  19. Grammont PM, Baulot E (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 16:65–68

    CAS  PubMed  Google Scholar 

  20. Grammont PM, Trouilloud P, Laffay JP, Deries X (1987) Etude et réalisation d’une nouvelle prothèse d’épaule. Rhumatologie 39:407–418

    Google Scholar 

  21. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G (2006) Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 88:1742–1747

    Article  PubMed  Google Scholar 

  22. Post M (1987) Constrained arthroplasty of the shoulder. Orthop Clin North Am 18:455–462

    CAS  PubMed  Google Scholar 

  23. 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 44:273–280

    CAS  PubMed  Google Scholar 

  24. Rittmeister M, Kerschbaumer F (2001) Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg 10:17–22

    Article  CAS  PubMed  Google Scholar 

  25. Simovitch RW, Helmy N, Zumstein MA, Gerber C (2007) Impact of fatty infiltration of the teres minor muscle on the outcome of reverse total shoulder arthroplasty. J Bone Joint Surg Am 89:934–939

    Article  PubMed  Google Scholar 

  26. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C (2007) Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am 89:588–600

    Article  PubMed  Google Scholar 

  27. Sirveaux F, Favard L, Oudet D, Huguet D, Lautman S (2001) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive and non repairable cuff rupture. In: Walch G, Boileau P, Molé D (eds) 2000 Prothèses d’épaule…recul de 2 à 10 ans. Suramps Médical, Paris, pp 247–252

  28. 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

    Article  PubMed  Google Scholar 

  29. Wall B, Walch G (2007) Reverse shoulder arthroplasty for the treatment of proximal humeral fractures. Hand Clin 23:425–430, v–vi

    Google Scholar 

  30. Werner CM, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 87:1476–1486

    Article  CAS  PubMed  Google Scholar 

  31. Williams GR Jr, Rockwood CA Jr (1996) Hemiarthroplasty in rotator cuff-deficient shoulders. J Shoulder Elbow Surg 5:362–367

    Article  PubMed  Google Scholar 

  32. Worland RL, Arredondo J (1998) Bipolar shoulder arthroplasty for painful conditions of the shoulder. J Arthroplasty 13:631–637

    Article  CAS  PubMed  Google Scholar 

  33. Worland RL, Jessup DE, Arredondo J, Warburton KJ (1997) Bipolar shoulder arthroplasty for rotator cuff arthropathy. J Shoulder Elbow Surg 6:512–515

    Article  CAS  PubMed  Google Scholar 

  34. Zuckerman JD, Scott AJ, Gallagher MA (2000) Hemiarthroplasty for cuff tear arthropathy. J Shoulder Elbow Surg 9:169–172

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Stefan H. Greiner, David A. Back, Sebastian Herrmann & Carsten Perka

  2. Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Patrick Asbach

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  1. Stefan H. Greiner
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  2. David A. Back
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  3. Sebastian Herrmann
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  4. Carsten Perka
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Correspondence to Stefan H. Greiner.

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Greiner, S.H., Back, D.A., Herrmann, S. et al. Degenerative changes of the deltoid muscle have impact on clinical outcome after reversed total shoulder arthroplasty. Arch Orthop Trauma Surg 130, 177–183 (2010). https://doi.org/10.1007/s00402-009-1001-y

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  • DOI: https://doi.org/10.1007/s00402-009-1001-y

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