Clin Orthop Surg.  2019 Mar;11(1):112-119. 10.4055/cios.2019.11.1.112.

Prognostic Radiological Factors Affecting Clinical Outcomes of Reverse Shoulder Arthroplasty in the Korean Population

• Rhee SM
• Lee JD
• Park YB
• Yoo JC
• Oh JH

• KMID: 2438341
• DOI: http://doi.org/10.4055/cios.2019.11.1.112

Abstract

BACKGROUND
Despite the growing use of reverse shoulder arthroplasty (RSA), it is associated with relatively frequent complications and uncertain clinical outcomes. We investigated radiological factors affecting clinical outcomes of RSA in the Korean population.
METHODS
We evaluated physical findings, radiographic findings, visual analog scale scores for pain and satisfaction, and several functional scores in 179 consecutive patients who underwent RSA at two centers between 2008 and 2014.
RESULTS
In 146 included RSAs, pain and forward flexion improved with deltoid lengthening (average, 23.5 ± 9.1 mm; p = 0.039). External rotation decreased with medialization (average, 16.8 ± 6.0 mm, p = 0.025), whereas internal rotation showed no correlation with humeral retroversion. Scapular notching (n = 44, 30%) significantly decreased with greater inferior glenosphere overhang (average, 2.94 ± 3.0 mm; p = 0.001), greater prosthesis scapular neck angle (average, 104°± 10.3°; p = 0.001), greater glenoid neck length (average, 9.8 ± 2.54 mm; p = 0.012), lower inferior baseplate tilt angle (average, 105.5°± 9.2°; p = 0.009), and varus humeral neck-shaft angle (p = 0.046), and it did not affect ranges of motion and pain, satisfaction, and functional scores. At the final follow-up, medialization was related to improvement in pain and satisfaction, and inferior glenosphere overhang to functional scores.
CONCLUSIONS
Proper amount of deltoid lengthening (mean, 2.3 cm) and inferior glenosphere overhang (mean, 2.9 mm) should be chosen for the better outcomes, while the center of rotation should be individualized according to patient characteristics in the Korean population.

Keyword

Rotator cuff tear arthropathy; Reverse shoulder arthroplasty; Prognostic factors; Patient outcomes; Korean population

MeSH Terms

Arthroplasty*
Follow-Up Studies
Humans
Neck
Prostheses and Implants
Shoulder*
Visual Analog Scale

Figure

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  Fig. 1 (A) Preoperatively, the center of rotation (COR), deltoid length (d), and glenoid neck length were measured. (B) Postoperative center of rotation (COR′) and deltoid length (d′) were measured at 4 weeks after surgery. (C) Glenosphere overhang, inferior baseplate tilt angle (θ), and prosthesis scapular neck angle (θ′) were also measured.

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  Fig. 2 Greater deltoid lengthening (average, 23.5 ± 9.1 mm; p = 0.04) was significantly correlated with increased active forward flexion (FF) postoperatively.

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  Fig. 3 Greater medialization of the center of rotation (COR; average, 16.8 ± 6.0 mm; p = 0.03) was significantly associated with decreased external rotation (ER) at the side.

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  Fig. 4 Receiver operating characteristic (ROC) curve analysis indicates that inferior glenosphere overhang (area under curve, 0.77; cutoff value, 2.645 mm) is the most important factor in preventing notching. AUC: area under curve, PSNA: prosthesis scapular neck angle, IBPT: inferior baseplate tilt angle.

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