Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching
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Originalarbeit Obere Extremität 2020 · 15:207–212 https://doi.org/10.1007/s11678-020-00594-w Received: 17 June 2020 Accepted: 4 August 2020 Published online: 11 August 2020 © The Author(s) 2020
Patric Raiss · Rainer Neumann OCM, Munich, Germany
Bipolar lateralization in reverse shoulder arthroplasty for avoidance of scapular notching Short-term results
Reverse shoulder arthroplasty (RSA) has become a well-established treatment option for multiple disorders of the shoulder joint [1–4]. Significant pain relief and improvement of function have been published [2–5]. The implant concept introduced by Paul Grammont with a medialized center of rotation on the glenoid side and a 155° neck–shaft angle on the humeral side has shown good long-term results [1, 6, 7]. Initially, complications such as dislocations and infections were frequent, but decreased substantially with surgeons’ growing experience [1]. The radiographic phenomenon of scapular notching describes impingement of the polyethylene liner against the scapular neck, leading to wear debris and potential loosening of components in the long term [8]. Therefore, in recent years implant designs and configurations have been modified. In order to avoid scapular notching, inferior baseplate positioning as well as lateralization on the glenoid side with bone grafting from the humeral head or with metallic augmentation became popular [9, 10]. Alongside lateralization, bone defects on the glenoid as well as glenoid version and inclination can be addressed by augmentation [9, 10]. On the humeral side the neck–shaft angle was modified by some manufactures to 145- or 135-degree inclination. First results for lateralization on the glenoid or humeral side are promising; however, results for bipolar lateralization in RSA are limited [2, 11]. An excellent option for virtual testing aimed at an “impingement-free” range
of motion is represented by CT-based three-dimensional (3D) planning tools [12]. The purpose of this study was to analyze the short-term results of a consecutive cohort of patients treated with RSA and bipolar lateralization who underwent preoperative CT-based 3D planning. The hypothesis was that clinical results improve over time and that scapular notching can be effectively avoided.
Methods General information Between March 2017 and January 2019, a consecutive series of 38 RSAs with bipolar lateralization were performed in one institution by the first author (PR). In all cases the same RSA system was used (Wright Medical Inc., Memphis, TN, USA). Patients were included in a prospectively recorded database; however, data analysis was performed in a retrospective fashion. All patients were seen in routine clinical controls. Inclusion criteria were the following: 1. preoperative CT-based 3D planning, 2. treatment with the same reverse shoulder implant, 3. complete clinical and radiographic data, and 4. a minimum follow-up of 12 months. The 38 replacements were performed in 37 patients. Mean age at the time of surgery was 75 years (range 48–86 years). There were 28 women an
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