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Patient Posture Affects Simulated ROM in Reverse Total Shoulder Arthroplasty: A Modeling Study Using Preoperative
Philipp Moroder1, Manuel Urvoy2, Patric Raiss3
1Department for Shoulder and Elbow Surgery, Charité - Universitätsmedizin, Berlin, Germany.
Clinical Orthopaedics and Related Research
|October 20, 2021
Summary
Patient posture significantly impacts reverse total shoulder arthroplasty (RTSA) range of motion (ROM). Individualizing implant components can mitigate negative effects of certain postures, improving outcomes for patients undergoing RTSA.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Medical imaging analysis
Background:
- Component selection and placement in reverse total shoulder arthroplasty (RTSA) remain debated.
- Scapulothoracic orientation and patient posture are increasingly recognized as critical factors in RTSA planning.
- The influence of posture on range of motion (ROM) and the potential for modifiable implant configurations to improve ROM in diverse patient postures require further investigation.
Purpose of the Study:
- To investigate how patient posture influences simulated ROM following virtual RTSA.
- To determine if modifying implant configurations (humeral component inclination/retrotorsion, glenoid component size/centricity) can enhance simulated ROM in patients with different postures.
Main Methods:
- Analysis of whole-torso CT scans from 30 patients to classify posture types (A, B, C) based on scapular internal rotation.
- Virtual RTSA implantation by three surgeons using 3D planning software, generating 3720 unique implant configurations.
- Simulation of maximum potential ROM for each configuration and analysis of posture effects on ROM outcomes.
Main Results:
- Patient posture significantly affected simulated ROM in all planes except flexion, irrespective of implant configuration.
- Patients with Type C (kyphotic) posture exhibited significantly reduced adduction, abduction, extension, and external rotation compared to Type A (upright) posture.
- Specific configurations (e.g., lower retrotorsion, higher neck-shaft angle, small concentric glenosphere) worsened ROM in Type C patients, while higher retrotorsion, lower neck-shaft angle, and larger/eccentric glenosphere showed potential benefits.
Conclusions:
- Patient posture is a significant determinant of ROM after simulated RTSA, independent of implant design.
- Personalized implant component selection tailored to scapulothoracic orientation can potentially offset adverse postural effects.
- Future RTSA research and clinical practice should incorporate patient posture and scapulothoracic orientation for optimized ROM outcomes.
