Can Distalisation and Lateralisation Shoulder Angles in Reverse Arthroplasty Interfere with the Functional Results in Patients with Rotator Cuff Arthropathy?

Abstract

Objective: To evaluate the influence of radiographic values on clinical and functional results in patients treated with reverse arthroplasty for rotator cuff arthropathy (RCA) using a lateralized design.

Methods: A retrospective analysis was performed. Patient demographics were recorded, as well as preoperative and postoperative range of motion. Function was calculated using the Constant-Murley score both before and after the procedure. Pre and postoperative anteroposterior and axial radiographs of the affected shoulder were analysed. In the preoperative images, the following was calculated: acromiohumeral distance (AHD) and lateral humeral offset (LHO). Postoperative measurements included: AHD, LHO, distalization shoulder angle (DSA) and lateralisation shoulder angle (LSA). Linear regression and quadratic regression analysis was performed to determine their degree of association with final functional outcomes. By applying a quadratic regression analysis and ROC curves, the cut-off values were determined with respect to the above-mentioned angles and the positive predictive value was calculated.

Results: The greater anterior elevation (AE) ranges were found with DSA between 40-45° and LSA among 80°- 90°, while better ABD was observed with LSA of 90-100°. Preoperative AHD was correlated to RE (r_s:0.47; p:0.049). Postoperative AHD was found to be in a directly proportional relationship with AE (r_s:0.49; p:0.03). Postoperative ABD showed an inverse linear regression with preoperative AHD (r_s: -0.44, p:0.047). LSA and DSA were inversely related.

Conclusion: We found that a DSA between 40-45° and a LSA of 80-100° could lead to better range of motion regarding AE and ABD in patients with rotator cuff arthropathy treated with RSA.

Keywords

arthroplasty - rotator cuff - shoulder

Work developed at the Hospital Británico de Buenos Aires, Buenos Aires, Argentina.

Publication History

Received: 26 October 2022

Accepted: 18 January 2023

Article published online:
21 March 2024

• Referências

• 1 Grammont P, Trouilloud P, Laffay J. et al. Étude et réalisation d'une nouvelle prothèse d'épaule. Rhumatol 1987; 39: 407-418
• 2 Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 1993; 16 (01) 65-68
• 3 Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 2005; 14 (1, Suppl S) 147S-161S
• 4 Katz D, Valenti P, Kany J, Elkholti K, Werthel JD. Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up. Int Orthop 2016; 40 (01) 99-108
• 5 Berthold DP, Morikawa D, Muench LN. et al. Negligible Correlation between Radiographic Measurements and Clinical Outcomes in Patients Following Primary Reverse Total Shoulder Arthroplasty. J Clin Med 2021; 10 (04) 809
• 6 Greiner S, Schmidt C, Herrmann S, Pauly S, Perka C. Clinical performance of lateralized versus non-lateralized reverse shoulder arthroplasty: a prospective randomized study. J Shoulder Elbow Surg 2015; 24 (09) 1397-1404
• 7 Lädermann A, Denard PJ, Boileau P. et al. Effect of humeral stem design on humeral position and range of motion in reverse shoulder arthroplasty. Int Orthop 2015; 39 (11) 2205-2213
• 8 Boutsiadis A, Lenoir H, Denard PJ. et al. The lateralization and distalization shoulder angles are important determinants of clinical outcomes in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27 (07) 1226-1234
• 9 Greene WB, Heckman JD. The clinical measurement of joint motion. Rosemont, Illinois: American Academy of Orthopaedic Surgeons; 1994: 5-26
• 10 Levy JC, Everding NG, Gil Jr CC, Stephens S, Giveans MR. Speed of recovery after shoulder arthroplasty: a comparison of reverse and anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23 (12) 1872-1881
• 11 Avers D. Técnicas de balance muscular. In: Daniels and Worthingham. Técnicas de exploración manual y pruebas funcionales. New York: Elsevier; 2014: 115-123
• 12 Gómez D, Dainotto T, Moya D, Patiño JM. Traducción y adaptación transcultural del Constant-Murley Score al español de la Argentina. RAAOT 2022; 87 (04) 579-592
• 13 Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 1990; (254) 92-96
• 14 Mahendraraj KA, Colliton E, Muniz A, Menendez ME, Jawa A. Assessing the validity of the distalization and lateralization shoulder angles following reverse total shoulder arthroplasty. Semin Arthroplast JSES 2020; 30 (04) 291-296
• 15 Beltrame A, Di Benedetto P, Cicuto C, Cainero V, Chisoni R, Causero A. Onlay versus Inlay humeral steam in Reverse Shoulder Arthroplasty (RSA): clinical and biomechanical study. Acta Biomed 2019; 90 (12-S): 54-63
• 16 Jeon YS, Rhee YG. Factors associated with poor active anterior elevation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27 (05) 786-793
• 17 Jobin CM, Brown GD, Bahu MJ. et al. Reverse total shoulder arthroplasty for cuff tear arthropathy: the clinical effect of deltoid lengthening and center of rotation medialization. J Shoulder Elbow Surg 2012; 21 (10) 1269-1277
• 18 Lädermann A, Denard PJ, Collin P. et al. Effect of humeral stem and glenosphere designs on range of motion and muscle length in reverse shoulder arthroplasty. Int Orthop 2020; 44 (03) 519-530
• 19 Lädermann A, Tay E, Collin P. et al. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 2019; 8 (08) 378-386
• 20 Goetti P, Denard PJ, Collin P, Ibrahim M, Mazzolari A, Lädermann A. Biomechanics of anatomic and reverse shoulder arthroplasty. EFORT Open Rev 2021; 6 (10) 918-931
• 21 Werner BC, Wong AC, Mahony GT. et al. Causes of poor postoperative improvement after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25 (08) e217-e222
• 22 Boileau P, Moineau G, Roussanne Y, O'Shea K. Bony Increased Offset-Reversed Shoulder Arthroplasty (BIO-RSA). JBJS Essential Surg Tech 2017; 7 (04) e37
• 23 Valenti P, Sauzières P, Katz D, Kalouche I, Kilinc AS. Do less medialized reverse shoulder prostheses increase motion and reduce notching?. Clin Orthop Relat Res 2011; 469 (09) 2550-2557
• 24 Bauer S, Corbaz J, Athwal GS, Walch G, Blakeney WG. Lateralization in Reverse Shoulder Arthroplasty. J Clin Med 2021; 10 (22) 5380
• 25 Paszicsnyek A, Jo O, Rupasinghe HS. et al. Factors Influencing Acromial and Scapular Spine Strain after Reverse Total Shoulder Arthroplasty: A Systematic Review of Biomechanical Studies. J Clin Med 2022; 11 (02) 361
• 26 Lädermann A, Williams MD, Melis B, Hoffmeyer P, Walch G. Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elbow Surg 2009; 18 (04) 588-595
• 27 Kim HJ, Kwon TY, Jeon YS, Kang SG, Rhee YG, Rhee SM. Neurologic deficit after reverse total shoulder arthroplasty: correlation with distalization. J Shoulder Elbow Surg 2020; 29 (06) 1096-1103
• 28 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 (05) 527-540
• 29 Bacle G, Nové-Josserand L, Garaud P, Walch G. Long-term outcomes of reverse total shoulder arthroplasty. J Bone Joint Surg Am 2017; 99 (06) 454-461
• 30 Müller AM, Born M, Jung C. et al. Glenosphere size in reverse shoulder arthroplasty: is larger better for external rotation and abduction strength?. J Shoulder Elbow Surg 2018; 27 (01) 44-52