Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Influence of lateralized versus medialized reverse shoulder arthroplasty design on external and internal rotation: a systematic review and meta-analysis

  • Kevin A. Hao (College of Medicine, University of Florida) ;
  • Robert J. Cueto (College of Medicine, University of Florida) ;
  • Christel Gharby (College of Medicine, University of Florida) ;
  • David Freeman (College of Medicine, University of Florida) ;
  • Joseph J. King (Department of Orthopaedic Surgery and Sports Medicine, University of Florida) ;
  • Thomas W. Wright (Department of Orthopaedic Surgery and Sports Medicine, University of Florida) ;
  • Diana Almader-Douglas (Clinic Library, Mayo Clinic Scottsdale) ;
  • Bradley S. Schoch (Department of Orthopedic Surgery, Mayo Clinic) ;
  • Jean-David Werthel (Hopital Ambroise Pare, Orthopedic Department)
  • Received : 2023.07.01
  • Accepted : 2023.09.03
  • Published : 2024.03.01
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Abstract

Background: Restoration of external (ER) and internal rotation (IR) after Grammont-style reverse shoulder arthroplasty (RSA) is often unreliable. The purpose of this systematic review was to evaluate the influence of RSA medio-lateral offset and subscapularis repair on axial rotation after RSA. Methods: We conducted a systematic review of studies evaluating axial rotation (ER, IR, or both) after RSA with a defined implant design. Medio-lateral implant classification was adopted from Werthel et al. Meta-analysis was conducted using a random-effects model. Results: Thirty-two studies reporting 2,233 RSAs were included (mean patient age, 72.5 years; follow-up, 43 months; 64% female). The subscapularis was repaired in 91% (n=2,032) of shoulders and did not differ based on global implant lateralization (91% for both, P=0.602). On meta-analysis, globally lateralized implants achieved greater postoperative ER (40° [36°-44°] vs. 27° [22°-32°], P<0.001) and postoperative improvement in ER (20° [15°-26°] vs. 10° [5°-15°], P<0.001). Lateralized implants with subscapularis repair or medialized implants without subscapularis repair had significantly greater postoperative ER and postoperative improvement in ER compared to globally medialized implants with subscapularis repair (P<0.001 for both). Mean postoperative IR was reported in 56% (n=18) of studies and achieved the minimum necessary IR in 51% of lateralized (n=325, 5 cohorts) versus 36% (n=177, 5 cohorts) of medialized implants. Conclusions: Lateralized RSA produces superior axial rotation compared to medialized RSA. Lateralized RSA with subscapularis repair and medialized RSA without subscapularis repair provide greater axial rotation compared to medialized RSA with subscapularis repair. Level of evidence: 2A.

Keywords

References

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