Glenohumeral osteoarthritis with intact rotator cuff treated with reverse shoulder arthroplasty: a systematic review
These authors aimed to summarize the current literature for rotator cuff intact osteoarthritis treated with primary reverse shoulder arthroplasty (RSA) and to determine whether morphological changes in the glenoid led to inferior outcomes.
They reviewed 13 studies reporting a minimum of 1 year followup for RSA in a total of 460 cases with rotator cuff intact osteoarthritis.
Patient reported outcomes were significantly improved for the Constant score but not for VAS, ASES, or Simple Shoulder Test scores.
The overall mean rate of major complication was 3.8%. The mean complication rate was 4.7% among shoulders with “static posterior instability”, “severe posterior subluxation”, “posterior glenoid wear >20º”, “significant posterior glenoid bone loss”, “biconcave glenoid”, “B2 glenoid”, and/or “B/C glenoid”.
Comment: The authors state that their study supports the use of reverse total shoulder in the treatment of intact rotator cuff osteoarthritis with reverse shoulder replacement. However the outcomes from this review do not seem to match those achieved with anatomic total shoulder arthroplasty, even for shoulders with glenoid deficiencies and retroversion. Compare the clinical improvement in the Simple Shoulder Test reported above to that in the two articles below.
We conclude that at present evidence is lacking that reverse total shoulder is superior to anatomic total shoulder arthroplasty for patients with primary osteoarthritis and an intact rotator cuff.
This study evaluated the ability of shoulder arthroplasty using a standard glenoid component to improve patient self-assessed comfort and function and to correct preoperative humeral-head decentering on the face of the glenoid in patients with primary glenohumeral arthritis and type-B2 or B3 glenoids. The SST score improved from 3.2 ± 2.1 points preoperatively to 9.9 ± 2.4 points postoperatively (p < 0.001) at a mean time of 2.8 ± 1.2 years for type-B2 glenoids and from 3.0 ± 2.5 points preoperatively to 9.4 ± 2.1 points postoperatively (p < 0.001) at a mean time of 2.9 ± 1.5 years for type-B3 glenoids; these results were not inferior to those for shoulders with other glenoid types. The mean humeral-head decentering on the glenoid face was reduced for type-B2 glenoids from -14% ± 7% preoperatively to -1% ± 2% postoperatively (p < 0.001) and for type-B3 glenoids from -4% ± 6% preoperatively to -1% ± 3% postoperatively (p = 0.027). The rates of bone integration into the central peg for type-B2 glenoids (83%) and type-B3 glenoids (81%) were not inferior to those for other glenoid types
In a population of patients undergoing TSA in whom no specific efforts were made to change the version of the glenoid, the authors asked whether at 2 years after surgery patients having glenoid components implanted in 15° or greater retroversion had (1) less improvement in the Simple Shoulder Test (SST) score and lower SST scores; (2) higher percentages of central peg lucency, higher Lazarus radiolucency grades, higher mean percentages of posterior decentering, and more frequent central peg perforation; or (3) a greater percentage having revision for glenoid component failure compared with patients with glenoid components implanted in less than 15° retroversion.
The mean (± SD) improvement in the SST (6.7 ± 3.6; from 2.6 ± 2.6 to 9.3 ± 2.9) for the retroverted group was not inferior to that for the nonretroverted group (5.8 ± 3.6; from 3.7 ± 2.5 to 9.4 ± 3.0). The mean difference in improvement between the two groups was 0.9 (95% CI, - 2.5 to 0.7; p = 0.412). The percent of maximal possible improvement (%MPI) for the retroverted glenoids (70% ± 31%) was not inferior to that for the nonretroverted glenoids (67% ± 44%). The mean difference between the two groups was 3% (95% CI, - 18% to 12%; p = 0.857). The 2-year SST scores for the retroverted (9.3 ± 2.9) and the nonretroverted glenoid groups (9.4 ± 3.0) were similar (mean difference, 0.2; 95% CI, - 1.1 to 1.4; p = 0.697). No patient in either group reported symptoms of subluxation or dislocation. The radiographic results for the retroverted glenoid group were similar to those for the nonretroverted group with respect to central peg lucency (four of 21 [19%] versus six of 50 [12%]; p = 0.436; odds ratio, 1.7; 95% CI, 0.4-6.9), average Lazarus radiolucency scores (0.5 versus 0.7, Mann-Whitney U p value = 0.873; Wilcoxon rank sum test W = 512, p value = 0.836), and the mean percentage of posterior humeral head decentering (3.4% ± 5.5% versus 1.6% ± 6.0%; p = 0.223). The percentage of patients with retroverted glenoids undergoing revision (0 of 21 [0%]) was not inferior to the percentage of those with nonretroverted glenoids (three of 50; [6%]; p = 0.251).
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link). How to x-ray the shoulder (see this link). The total shoulder arthroplasty (see this link). The ream and run technique is shown in this link. The cuff tear arthropathy arthroplasty (see this link). The reverse total shoulder arthroplasty (see this link). Shoulder rehabilitation exercises (see this link).
Follow on twitter: Frederick Matsen (@shoulderarth)
