Abstract
Background
Scapular notching, prosthetic instability, limited shoulder rotation and loss of shoulder contour are associated with conventional medialized design reverse shoulder arthroplasty. Prosthetic (ie, metallic) lateralization increases torque at the baseplate-glenoid interface potentially leading to failure.
Questions/purposes
We asked whether bony lateralization of reverse shoulder arthroplasty would avoid the problems caused by humeral medialization without increasing torque or shear force applied to the glenoid component.
Patients and Methods
We prospectively followed 42 patients with rotator cuff deficiency treated with bony increased-offset reverse shoulder arthroplasty. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate. Graft and baseplate fixation was achieved using a lengthened central peg (25 mm) and four screws. Patients underwent clinical, radiographic, and CT assessment at a minimum of 2 years after surgery.
Results
The humeral graft incorporated completely in 98% of cases (41 of 42) and partially in one. At a mean of 28 months postoperatively, no graft resorption, glenoid loosening, or postoperative instability was observed. Inferior scapular notching occurred in 19% (eight of 42). The absolute Constant-Murley score improved from 31 to 67. Thirty-six patients (86%) were able to internally rotate sufficiently to reach their back over the sacrum.
Conclusions
Grafting of the glenoid surface during reverse shoulder arthroplasty effectively creates a long-necked scapula, providing the benefits of lateralization. Bony increased-offset reverse shoulder arthroplasty is associated with low rates of inferior scapular notching, improved shoulder rotation, no prosthetic instability and improved shoulder contour. In contrast to metallic lateralization, bony lateralization has the advantage of maintaining the prosthetic center of rotation at the prosthesis-bone interface, thus minimizing torque on the glenoid component.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Abrassart S, Stern R, Hoffmeyer P. Arterial supply of the glenoid: an anatomic study. J Shoulder Elbow Surg. 2006;15:232–238.
Antuna S, Sperling JW, Cofield RH. Reimplantation of a glenoid component after component removal and allograft bone grafting: a report of 3 cases. J Shoulder Elbow Surg. 2002;11:637–641.
Baulot E, Chabernaud D, Grammont PM. Results of Grammont’s inverted prosthesis in omarthritis associated with major cuff destruction: apropos of 16 cases [in French]. Acta Orthop Belg. 1995;61(Suppl 1):112–119.
Boileau P, Chuinard C, Roussanne Y, Bicknell RT, Rochet N, Trojani C. Reverse shoulder arthroplasty combined with a modified latissimus dorsi and teres major tendon transfer for shoulder pseudoparalysis associated with dropping arm. Clin Orthop Relat Res. 2008;466:584–593.
Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14(1 Suppl):147S–161S.
Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006;15:527–540.
Boulahia A, Edwards TB, Walch G, Baratta RV. Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. Orthopedics. 2002;25:129–133.
Constant CR, Murley AH. A clinical method for functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.
Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am. 2008;90:1244–1251.
Ellman H, Hanker G, Bayer M. Repair of the rotator cuff: end-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:1136–1144.
Favard L, Lautmann S, Sirveaux F. Hemi arthroplasty 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 Ten year Follow-up. Montpellier, France: Sauramps Medical; 2001:261–268.
Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a minimum two-year follow-up study of sixty patients: surgical technique. J Bone Joint Surg Am. 2006;88(Suppl 1):178–190.
Gerber C, Pennington SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009;17:284–295.
Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg. 2007;16:717–721.
Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65–68.
Guéry J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty: survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 2006;88:1742–1747.
Gutiérrez S, Luo ZP, Levy J, Frankle MA. Arc of motion and socket depth in reverse shoulder implants. Clin Biomech (Bristol, Avon). 2009;24:473–479.
Harman M, Frankle M, Vasey M, Banks S. Initial glenoid component fixation in ‘reverse’ total shoulder arthroplasty: a biomechanical evaluation. J Shoulder Elbow Surg. 2005;14(1 Suppl S):162S–167S.
Hatzidakis AM, Norris TM, Boileau P. Reverse shoulder arthroplasty: indications, techniques, and results. Tech Shoulder Elbow Surg. 2005;6:135–149.
Hill JM, Norris TR. Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid. J Bone Joint Surg Am. 2001;83:877–883.
Lévigne C, Boileau P, Favard L, Garaud P, Molé D, Sirveaux F, Walch G. Scapular notching in reverse shoulder arthroplasty. In: Walch G, Boileau P, Molé D, Favard L, Lévigne C, Sirveaux F, eds. Reverse Shoulder Arthroplasty. Montpellier, France: Sauramps Medical; 2006:353–372.
Matsen FA 3rd, Boileau P, Walch G, Gerber C, Bicknell RT. The reverse total shoulder arthroplasty. Instr Course Lect. 2008;57:167–174.
Middernacht B, De Roo PJ, Van Maele G, De Wilde LF. Consequences of scapular anatomy for reversed total shoulder arthroplasty. Clin Orthop Relat Res. 2008;466:1410–1418.
Molé D, Favard L. Excentred scapulohumeral osteoarthritis [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2007;93(6 Suppl):37–94.
Neyton L, Boileau P, Nove-Josserand L, Edwards TB, Walch G. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007;16(3 Suppl):S71–S78.
Nové-Josserand L, Walch G. Instability after reverse shoulder arthroplasty. In: Walch G, Boileau P, Molé D, Favard L, Lévigne C, Sirveaux F, eds. Reverse Shoulder Arthroplasty. Montpellier, France: Sauramps Medical; 2006:81–101.
Nyffeler RW, Werner CM, Gerber C. Biomechanical relevance of glenoid component positioning in the reverse Delta III total shoulder prosthesis. J Shoulder Elbow Surg. 2005;14:524–528.
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3:347–352.
Seebauer L. Total reverse shoulder arthroplasty: European lessons and future trends. Am J Orthop. 2007;36(Suppl 1):22–28.
Seebauer L, Walter W, Keyl W. Reverse total shoulder arthroplasty for the treatment of defect arthropathy. Oper Orthop Traumatol. 2005;17:1–24.
Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89:588–600.
Sirveaux F, Favard L, Oudet D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive cuff rupture of the cuff: results of a multicenter study of 80 shoulders. J Bone Joint Surg Br. 2004;86:388–395.
Sirveaux F, Favard L, Oudet D, Huguet D, Lautman S. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive and non repairable cuff rupture. In: Walch G, Boileau P, Mole D, eds. 2000 Shoulder Prostheses: Two to Ten Year Follow-up. Montpellier, France: Sauramps Medical; 2001:247–252.
Terrier A, Reist A, Merlini F, Farron A. Simulated joint and muscle forces in reversed and anatomic shoulder prostheses. J Bone Joint Surg Br. 2008;90:751–756.
Valenti P, Sauzieres P, Cogswell L, O’Toole G, Katz D. The reverse shoulder prosthesis: surgical technique. Tech Hand Up Extrem Surg. 2008;12:46–55.
Valenti PH, Boutens D, Nerot C. Delta 3 reversed prosthesis for osteoarthritis with massive rotator cuff tear: long term results (> 5 years). In: Walch G Boileau P, Mole D, eds. 2000 Shoulder Prostheses: Two to Ten Year Follow-up. Montpellier, France: Sauramps Medical; 2001:253–259.
Vanhove B, Beugnies A. Grammont’s reverse shoulder prosthesis for rotator cuff arthropathy: a retrospective study of 32 cases. Acta Orthop Belg. 2004;70:219–225.
Von Schroeder HP, Kuiper SD, Botte MJ. Osseous anatomy of the scapula. Clin Orthop Relat Res. 2001;383:131–139.
Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999;14:756–760.
Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89:1476–1485.
Werner CM, Steinmann PA, Gilbart M, Gerber C. 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. 2005;87:1476–1486.
Author information
Authors and Affiliations
Corresponding author
Additional information
One author (PB) declares a commercial association (Tornier) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
About this article
Cite this article
Boileau, P., Moineau, G., Roussanne, Y. et al. Bony Increased-offset Reversed Shoulder Arthroplasty: Minimizing Scapular Impingement While Maximizing Glenoid Fixation. Clin Orthop Relat Res 469, 2558–2567 (2011). https://doi.org/10.1007/s11999-011-1775-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-011-1775-4