Range of motion after reverse shoulder arthroplasty: which combinations of humeral stem and glenosphere work best?
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Übersicht Obere Extremität 2020 · 15:172–178 https://doi.org/10.1007/s11678-020-00599-5 Received: 17 June 2020 Accepted: 11 August 2020 Published online: 3 September 2020 © The Author(s) 2020
Alexandre Lädermann1,2,3
· Philippe Collin4 · Patrick J. Denard5
1
Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland Faculty of Medicine, University of Geneva, Geneva, Switzerland 3 Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland 4 Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France 5 Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, USA 2
Range of motion after reverse shoulder arthroplasty: which combinations of humeral stem and glenosphere work best? Introduction The initial reverse shoulder arthroplasty (RSA) design was excellent at restoring forward flexion, but had several designrelated complications including bony impingement and scapular notching [31, 38], instability [5], acromial fractures [19], limited range of motion (ROM) (particularly internal and external rotation; [20, 29]), and humeral stem loosening [32, 38]. Many of these have been attributed to the initial Grammont design, which featured a medialized glenosphere and 155-degree straight stem (medial glenoid/medial humerus design) [12]. A variety of changes in prosthetic design have been proposed to address these issues either on the humeral side or on the glenoid side, the goal being to decrease scapularnotching, maximize efficiencyof the remaining rotator cuff, and improve stability as well as ROM. On the glenoid side, authors have promoted increased lateralization either with bone or metal [4, 15]. On the humeral side, a more anatomic humeral inclination (i.e., 145 or 135 degrees) and inlay and onlay system designs have introduced a myriad of prosthetic configurations that has rendered analysis and delivery of universal guidelines difficult. Therefore, the aim of this review was to evaluate the advantages and drawbacks
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of different RSA designs and to provide recommendations accordingly.
Glenoid configuration Glenoid configuration has an important effect on postoperative ROM. The three most important variables are glenoid offset, eccentricity, and glenosphere size. None of these latter parameters significantly influence the measured bone strains at the glenoid near the bone–implant interface [46].
Glenoid offset (lateralization) The initial Grammont-style RSA utilized a glenosphere with a medialized center of rotation. While this design reliably improved forward elevation, the high rate of scapular notching and internal and external rotation deficit observed with this design have been attributed to the medialized glenoid design [12, 35]. To address these problems, glenoid lateralization has been proposed to decrease scapular notching, improve soft tissue tension, and increase impingement-free ROM. The glenoid component is considered as lateralized if lateralization eq
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