These authors assessed the outcomes of two Wright Medical reverse total shoulder designs: Grammont (below left) or an onlay curved short-stem humeral component (below right) in 68 patients with cuff tear arthropathy.
Both prostheses provided significant differences between preoperative and postoperative scores and both provided similar postoperative shoulder mobility.
The lateralized curved stem was associated with higher delta scores for external rotation (P = .002) and lower rates of scapular notching (P = .0003), glenoid radiolucency (P = .016), and humeral bone remodeling (P = .004 and P = .030 for cortical thinning and spot weld, respectively).
Complications were reported for 8% (3 of the 36) Aequalis II Grammont prostheses: two dislocations and one "feeling of instability" all managed without surgical revision.
Complications were reported for 18% (7 of the 38) Ascend Flex curved stems: two fractures of the scapular spine (treated without surgery) and an acromial fracture treated with surgery. In this group there were three infections, and one case of instability. There were two shoulders in the Ascend Flex group that had prosthesis revision surgery: one because of instability and one because of infection.
Comment: It is not clear how patients were assigned to receive one prothesis or the other and it is not clear whether the same surgeons used both prostheses or whether some surgeons used the Grammont and other surgeons used the onlay short stem.
In any event, it is not clear from this study whether there is an advantage to the patient of one design or the other.
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