Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Radiologic Comparison of Humeral Position according to the Implant Designs Following Reverse Shoulder Arthroplasty: Analysis between Medial Glenoid/Medial Humerus, Lateral Glenoid/Medial Humerus, and Medial Glenoid/Lateral Humerus Designs

  • Cho, Nam Su (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Nam, Ju Hyun (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Hong, Se Jung (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Kim, Tae Wook (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Lee, Myeong Gu (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Ahn, Jung Tae (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Rhee, Yong Girl (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
  • Received : 2018.06.10
  • Accepted : 2018.07.30
  • Published : 2018.12.01
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Abstract

Background: The currently available reverse shoulder arthroplasty (RSA) designs can be classified into medial glenoid/medial humerus (MGMH), lateral glenoid/medial humerus (LGMH), and medial glenoid/lateral humerus (MGLH) prosthesis designs. The purpose of this study was to radiologically analyze the effect of different RSA designs on humeral position following RSA. Methods: A total of 50 patients who underwent primary RSA were retrospectively analyzed. Among 50 patients, 33 patients (group A: MGMH) underwent RSA with Aequalis system (Wright, Inc, Bloomington, MN, USA), 6 (group B: LGMH) with Aequalis system using bony increased offset, and 11 (group C: MGLH) with Aequalis Ascend Flex system. The acromiohumeral distance, acromioepiphyseal distance (AED), lateral humeral offset (LHO), LHO from the center of rotation ($LHO^{COR}$), and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. Results: The increment in postoperative AED was $19.92{\pm}3.93mm$ in group A, $24.52{\pm}5.25mm$ in group B, and $25.97{\pm}5.29mm$ in group C, respectively (p=0.001). The increment in postoperative LHO was $0.13{\pm}6.30mm$, $8.00{\pm}12.14mm$, and $7.42{\pm}6.88mm$, respectively (p=0.005). The increment in postoperative $LHO^{COR}$ was $20.76{\pm}6.06mm$, $22.04{\pm}5.15mm$, and $28.11{\pm}4.14mm$, respectively (p=0.002). Conclusions: The radiologic analysis of the effect of different RSA designs on humeral position following RSA showed significant differences in the increment in postoperative AED, LHO, and $LHO^{COR}$ between the 3 groups. Therefore, MGLH design seems to be more effective for humeral distalization and lateralization compared to original Grammont design.

Keywords

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A Fig. 1. Preoperative (A) and postoperative (B) acromiohumeral distance (AHD).

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A Fig. 2. Preoperative (A) and postoperative (B) acromioepiphyseal distance (AED).

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Fig. 3. Preoperative (A) and postoperative (B) lateral humeral offset (LHO). AHD: acromiohumeral distance.

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Fig. 4. Preoperative (A) and postoperative (B) lateral humeral offset from the center of rotation (LHOCOR). AHD: acromiohumeral distance.

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A Fig. 5. Preoperative (A) and postoperative (B) deltoid length.

Table 1. Group A (MGMH)

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Table 2. Group B (LGMH)

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Table 3. Group C (MGLH)

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Table 4. Preoperative and Postoperative Comparison among Groups A, B, and C

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Table 5. Comparison of Differences in Increment among Groups A, B, and C

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Table 6. Multiple Comparisons

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  1. Medialized versus Lateralized Center of Rotation in Reverse Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis vol.10, pp.24, 2018, https://doi.org/10.3390/jcm10245868