Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Ten technical aspects of baseplate fixation in reverse total shoulder arthroplasty for patients without glenoid bone loss: a systematic review

  • Reinier W.A. Spek (Department of Orthopaedic Surgery, Flinders University and Flinders Medical Center) ;
  • Lotje A. Hoogervorst (Department of Orthopaedics, Leiden University Medical Center) ;
  • Rob C. Brink (Department of Orthopaedic Surgery, OLVG Amsterdam) ;
  • Jan W. Schoones (Walaeus Library, Leiden University Medical Center) ;
  • Derek F.P. van Deurzen (Department of Orthopaedic Surgery, OLVG Amsterdam) ;
  • Michel P.J. van den Bekerom (Department of Orthopaedic Surgery, OLVG Amsterdam)
  • Received : 2023.06.17
  • Accepted : 2023.08.17
  • Published : 2024.03.01
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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.

Keywords

Acknowledgement

The first author (RWAS) has received payments during the study period including <$10,000 from Anna Fonds NOREF (Mijdrecht, the Netherlands),<$10,000 from Michael-van Vloten Fonds (Rotterdam, the Netherlands), and an amount between $10,000-100,000 from Prins Bernhard Cultuurfonds (Amsterdam, the Netherlands) and Flinders Foundation (Adelaide, Australia).

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