As pointed out the previous blog post (Rocking horse loosening of the baseplate in reverse total shoulder arthroplasty) superiorly augmented baseplates are being used in reverse total shoulder arthroplasty (RSA) with superior gleniod wear, although the clinical benefit to the patient has yet to be demonstrated.
The authors of Utility of Superior Augments in Reverse Shoulder Arthroplasty (Exactech, Equinoxe GPS) without Significant Glenoid Deformity compared superior augments versus no augment baseplates in RSA for patients with rotator cuff dysfunction and no significant superior glenoid erosion in a multi surgeon retrospective analysis of 145 patients who underwent RSA with intraoperative navigation (Exactech, Equinoxe GPS). No specific guidelines were applied: the use of augmented and standard baseplates was determined by the individual surgeon.
Included patients had preoperative superior inclination less than 10 degrees and retroversion less than 15 degrees and had a minimum 20 month followup. Patients selected for augments had higher native superior inclination (5.9 vs. 1.4 degrees).
At final follow-up, active ROM in all planes was not different between the cohorts. Patient reported outcomes for the augment and non augment groups were not clinically significantly different (i.e. the difference did not exceed the published values for the minimal clinically important difference (MCID).
The adverse events are shown below
As noted in Rocking horse loosening of the baseplate in reverse total shoulder arthroplasty, the rate of acromial stress fractures appears to be higher in patients receiving RSA with augmented base plates.
The authors report that they were unable to assess final component positioning or quality of baseplate seating on postoperative imaging given the nature of the multi-center database.
Achieving good glenoid component seating can be a challenge when using augmented components (see https://shoulderarthritis.blogspot.com/2024/03/what-happens-when-glenoid-version-and.html).
Comment: As stated in Influence of Backside Seating Parameters and Augmented Baseplate Components in Virtual Planning for Reverse Shoulder Arthroplasty the use of planning software leads surgeons to chose an augmented glenoid baseplate approximately 85% of the time, even in the presence of minimal deformity. This is in comparison to a less than 20% use of augments when planning software is not used.
The value of augmented components in RSA remain to determined. If the cost of augmented components is greater than that of standard components, the increment in expense would ideally be offset by an increment in the benefit to the patient as demonstrated by comparing the clinical and radiographic outcomes in comparable shoulders.
You can support cutting edge shoulder research and education that are leading to better care for patients with shoulder problems, click on this link.
Follow on twitter: https://twitter.com/RickMatsen or https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
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 ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
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 ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
