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Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty

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Abstract

Purpose

To determine how different combinations of humeral stem and glenosphere designs for reverse shoulder arthroplasty (RSA) influence range of motion (ROM) and muscle elongation.

Methods

A computed tomography scan of a non-pathologic shoulder was used to simulate all shoulder motions, and thereby compare the ROM and rotator cuff muscle lengths of the native shoulder versus 30 combinations of humeral components (1 inlay straight stem with 155° inclination and five onlay curved stems with 135°, 145° or 155° inclinations, using concentric, medialized or lateralized trays) and glenospheres (standard, large, lateralized, inferior eccentric and bony increased-offset (BIO-RSA)).

Results

Only five of the 30 combinations restored ≥ 50% of the native ROM in all directions: the 145° onlay stem (concentric tray) combined with lateralized or inferior eccentric glenospheres and the 145° stem (lateralized tray) combined with either a large, lateralized or inferior eccentric glenosphere. Lengthening of the supraspinatus and infraspinatus, observed for all configurations, was greatest using onlay stems (7–30%) and BIO-RSA glenospheres (13–31%). Subscapularis lengthening was observed for onlay stems combined with BIO-RSA glenospheres (5–9%), while excessive subscapularis shortening was observed for the inlay stem combined with all glenospheres except the BIO-RSA design (> 15%).

Conclusions

The authors suggest implanting 145° onlay stems, with concentric or lateralized trays, together with lateralized or inferior eccentric glenospheres.

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Acknowledgements

The authors are grateful to Hugo Bothorel and Mo Saffarini for their assistance with statistical analysis and manuscript redaction.

Funding

This study was funded by a non-profit foundation for Research and Teaching in Orthopaedics, Sports Medicine, Trauma and Imaging (FORE), with no commercial interest in the present study. The sources of funds were involved in data analysis and manuscript redaction.

Author information

Authors and Affiliations

  1. Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland

    Alexandre Lädermann

  2. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Alexandre Lädermann

  3. Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

    Alexandre Lädermann

  4. Division of Orthopaedics and Trauma Surgery, Hirslanden Clinique La Colline, Geneva, Switzerland

    Alexandre Lädermann

  5. Southern Oregon Orthopedics, Medford, OR, USA

    Patrick J. Denard

  6. Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA

    Patrick J. Denard

  7. Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France

    Philippe Collin

  8. Service of Orthopedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland

    Olivia Zbinden

  9. Department of Orthopaedic Sports Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan

    Joe Chih-Hao Chiu

  10. iULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, University Côte d’Azur, Nice, France

    Pascal Boileau

  11. ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland

    Flora Olivier

  12. Centre Orthopédique Santy, Hôpital Privé Jean Mermoz Ramsay GDS, Lyon, France

    Gilles Walch

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  1. Alexandre Lädermann
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  2. Patrick J. Denard
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  5. Joe Chih-Hao Chiu
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  7. Flora Olivier
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  8. Gilles Walch
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Corresponding author

Correspondence to Flora Olivier.

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Ethical approval

As the study was performed using pre-existing CT scans of a cadaveric shoulder, institutional review board (IRB) approval was not required.

Conflict of interest

PB reports personal fees from Wright during the conduct of the study. PC reports personal fees from Wright, Stortz, Smith and Nephew and ConMed, during the conduct of the study; personal fees from Advanced Medical Applications, outside the submitted work. PJD reports personal fees from Arthrex, Medacta and Wright, during the conduct of the study and personal fees from Lippincott Williams & Wilkins, outside the submitted work. AL reports personal fees from Wright, Medacta, Arthrex and Wright during the conduct of the study. GW reports personal fees from Wright during the conduct of the study. OZ, JCHC and FO states that they have no conflict of interest.

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Lädermann, A., Denard, P.J., Collin, P. et al. Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty. International Orthopaedics (SICOT) 44, 519–530 (2020). https://doi.org/10.1007/s00264-019-04463-2

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