Clin Should Elbow.
2024 Mar;27(1):88-107. 10.5397/cise.2023.00493.
Ten technical aspects of baseplate fixation in reverse total shoulder arthroplasty for patients without glenoid bone loss: a systematic review
- Affiliations
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- 1Department of Orthopaedic Surgery, Flinders University and Flinders Medical Center, Adelaide, Australia
- 2Department of Orthopaedic Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
- 3Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- 4Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- 5Department of Biomedical Data Sciences and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
- 6Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
- 7Shoulder and Elbow Expertise Center, Amsterdam, the Netherlands
- 8Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- KMID: 2555284
- DOI: http://doi.org/10.5397/cise.2023.00493
Abstract
- The aim of this systematic review was to collect evidence on the following 10 technical aspects of glenoid baseplate fixation in reverse total shoulder arthroplasty (rTSA): screw insertion angles; screw orientation; screw quantity; screw length; screw type; baseplate tilt; baseplate position; baseplate version and rotation; baseplate design; and anatomical safe zones. Five literature libraries were searched for eligible clinical, cadaver, biomechanical, virtual planning, and finite element analysis studies. Studies including patients >16 years old in which at least one of the ten abovementioned technical aspects was assessed were suitable for analysis. We excluded studies of patients with: glenoid bone loss; bony increased offset-reversed shoulder arthroplasty; rTSA with bone grafts; and augmented baseplates. Quality assessment was performed for each included study. Sixty-two studies were included, of which 41 were experimental studies (13 cadaver, 10 virtual planning, 11 biomechanical, and 7 finite element studies) and 21 were clinical studies (12 retrospective cohorts and 9 case-control studies). Overall, the quality of included studies was moderate or high. The majority of studies agreed upon the use of a divergent screw fixation pattern, fixation with four screws (to reduce micromotions), and inferior positioning in neutral or anteversion. A general consensus was not reached on the other technical aspects. Most surgical aspects of baseplate fixation can be decided without affecting fixation strength. There is not a single strategy that provides the best outcome. Therefore, guidelines should cover multiple surgical options that can achieve adequate baseplate fixation.
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