The Delta XTEND is a Grammont - style reverse total shoulder arthroplasty. It achieves stability by non-physiologic distal and medial displacement of the humerus relative to the scapula as shown below.
These authors sought to determine the relationship between lowering and medialization of the humerus and the short-term functional results.
In 70 patients the mean humeral lowering was 25.4 mm (range, 6-38 mm), and the mean medialization was 9.2 mm (range, 0-20 mm).
At 1 year of follow-up, scapular notching was found in 20 shoulders (29%): type I notching was observed in 18 and type II notching in 2. At 2 years of follow-up, only 54 patients were available for a radiographic review. Scapular notching was found in 25 patients (46%): type I notching was observed in 15, type II notching in 7, and type III notching in 3. No scapular spine or acromion fractures occurred.
They divided the lowering values the cohort into terciles below 24 above 28 mm and in between.
They divided the lowering values the cohort into terciles below 24 above 28 mm and in between.
Active anterior elevation, which was somewhat greater in the group with >28 mm of lowering in comparison to the group with less than 24 mm of lowering. Neither the Constant-Murley score nor the pain score were influenced by the humeral lowering.
The rate of scapular notching was inconsistently related to the degree of lowering.
Comment: The high rate of scapular notching with this type of prosthesis (46%) is noted (example shown below).
Our preference is for a design that achieves stability with East - West tensioning, enabling a more anatomic reconstruction without the need for distalization, which may jeopardize the acromion and the brachial plexus.
The point is that the positioning of the implant depends a lot on the implant design.
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