Clinical and radiological comparison of three different reverse shoulder arthroplasty designs for patients with...

In reverse shoulder arthroplasty (RSA), different implant designs range from medializing implants to strongly lateralizing onlay designs with different neck-shaft-angles (NSA). Thus different degrees of lateralization are currently used. Aim of this study was to compare clinical and radiological outcomes of three different implant designs in a homogeneous patient cohort with primary osteoarthritis (OA).

Patients with OA who underwent RSA between 03/2014 and 01/2020 were included and categorized into three groups based on RSA design: group MD (medialized-distalized design: eccentric glenosphere, 155° NSA), group L (lateralized design: + 4 mm centric glenosphere, 135° NSA), group LD (lateralized-distalized design: eccentric glenospheres, + 3 mm baseplate, curved onlay stem 145° NSA). Inclusion criteria were complete clinical and radiological 24 months follow-up (FU) including range of motion (ROM), Constant-Murley score (CS), Subjective Shoulder Value (SSV). In addition, scapular notching and adverse events were recorded.

Group MD including 26 patients (81% female; mean age: 77.9 years) reached 71 (range: 60-85) points in CS and 90% (range: 40-100) in SSV. In group L, 46 patients (98% female; mean age: 75.2 years) achieved a CS of 75 (59-85) points and SSV was 95% (60-100). In group LD, 25 patients (68% female; mean age: 76.3 years) presented a CS of 79 (30-100) points and SSV of 93% (50-100). Group L and group LD achieved significantly better abduction, internal and external rotation (p < 0.001), forward flexion (p = 0.023) and SSV (p = 0.046). Scapular notching was present in 22% of MD patients (13% grade 1; 4% grade 2; 4% grade 4), 16% in group L (all grade 1) and 9% in group LD (all grade 2). No prosthesis related complication occurred in any group.

In patients with primary OA, the lateralized and lateralized-distalized designs result in superior subjective satisfaction in SSV and improved ROM in all planes compared to the traditional distalized-medialized implant designs. In all three groups, no implant related complications were noted.