These authors have introduced an onlay design reverse shoulder arthroplasty to overcome complications observed with the traditional Grammont-type prosthesis. This study aimed to determine the influence of arm lengthening on the short-term clinical outcome in onlay reverse shoulder arthroplasty and investigate the effect of humeral tray offset positioning on arm lengthening and range of motion in 56 patients at a minimum 2 years’ follow-up.
The Constant score improved from 25.5 to 71.5 points at a mean follow-up. Mean postoperative anterior elevation was 145.2° and external rotation was 30.7° Arm lengthening exceeding 2.5 cm was related to a decrease in anterior elevation.
Arm lengthening averaging 1 to 2.5 cm was found to be the best compromise on postoperative range of motion.
Postoperative complications occurred in 8 patients (14%) There was no significant difference in arm lengthening compared with patients without complications.
Three patients sustained a fracture of the acromion or scapular spine at 2, 3, and 36 months. All fractures were treated conservatively in an abduction brace for 6 weeks.
There were 2 dislocations at 3 and 18 months postoperatively treated with open reduction and exchange of the polyethylene liner.
A postoperative brachial palsy developed in 1 patient and was revised 8 weeks later. Arm lengthening compared with the contralateral side was 5 cm.
Aseptic glenoid loosening occurred in 1 patient at 25 months.
A chronic infection with Staphylococcus saprophyticus developed in 1 patient at 21 months.
Comment: These authors have developed a new design feature of the reverse total shoulder. It is not clear whether the ability to adjust the position of the humeral tray will improve outcomes or decrease complications. They point to the potential risks of over lengthening the arm.
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