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Reverse Total Shoulder Arthroplasty
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Optimizing range of motion in reverse shoulder arthroplasty.

Mark Mouchantaf1, Marco Parisi1, Gregorio Secci1

  • 1Institut de Chirurgie Réparatrice (ICR), Locomoteur & Sports, Nice, France.

Bone & Joint Open
|October 10, 2024
PubMed
Summary

Optimal glenoid implant positioning in reverse shoulder arthroplasty (RSA) improves range of motion (ROM). Lateralization and inclination correction, using angled augments, provide the best theoretical impingement-free ROM.

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Medical Imaging and Simulation

Background:

  • Reverse shoulder arthroplasty (RSA) is a common procedure for complex shoulder pathologies.
  • Achieving optimal glenoid implant positioning is critical for functional outcomes and preventing impingement.
  • Current techniques for glenoid positioning, including lateralization and inclination correction, are not consistently applied.

Purpose of the Study:

  • To determine the optimal glenoid implant configuration for maximizing impingement-free range of motion (ROM) in reverse shoulder arthroplasty (RSA).
  • To compare the theoretical ROM outcomes of different glenoid baseplate configurations using 3D planning software.

Main Methods:

  • A 3D planning software (Blueprint) was used to simulate four glenoid baseplate configurations in 41 RSA patients.
  • Configurations included variations in RSA angle correction and lateralization (no correction, medialization, superior compensation, lateralization).
  • All simulations used the same humeral inlay implant and a 135° inclined polyethylene liner.

Main Results:

  • The configuration with both lateralization and RSA angle correction (C+L+) significantly improved ROM in flexion, extension, adduction, and external rotation (p ≤ 0.001).
  • Internal rotation showed no significant difference between configurations (p = 0.388).
  • Medialization for inclination correction (C+M+) resulted in the poorest ROM across multiple planes.

Conclusions:

  • Correcting glenoid inclination to 0° and lateralizing the glenoid component using 8-10 mm augments optimizes impingement-free ROM in RSA with a 135° inlay reversed humeral implant.
  • This simulated approach offers a theoretical basis for improving surgical planning and patient outcomes in RSA.