Highlights
- •We suggest that change in neck shaft angle and retroversion can prevent scapular notching.
- •We measured shoulder range of motion with change in neck shaft angle (NSA) and retroversion.
- •As NSA and retroversion increase, the amount of adduction deficit also increases.
- •As NSA decreases, amount of total rotation increases.
- •As retroversion increases, amount of internal rotation behind back also increases.
Abstract
Background
We studied combined effect of change in humeral neck shaft angle and retroversion
on shoulder ROM in reverse total shoulder arthroplasty using 3-dimensional simulations.
Methods
Using a 3D model construct based on the CT scans of 3 males and a 3-dimensional analysis
program, a humeral component of reverse total shoulder arthroplasty was implanted
in 0°, 10°, 20°, 30°,40° retroversion and 135°, 145°, and 155° neck shaft angle. Total
horizontal range of motion (sum of horizontal adduction and abduction) at 30° and
60° scaption, adduction in the scapular plane and IR behind the back were measured
for various combinations of neck shaft angle and retroversion.
Findings
Change in retroversion didn't show any effect on total horizontal range of motion.
Total horizontal range of motion at both 30° and 60° scaption, showed maximum values
at 135° neck shaft angle and minimum values at 155° neck shaft angle. With any combination
of retroversion angles, adduction deficit was maximum at 155° neck shaft angle and
no adduction deficit at 135° neck shaft angle. Every 10° decrease in neck shaft angle
resulted in an average 10.4° increase in adduction. For every 10° increase in retroversion,
there was loss of internal rotation behind the back up to at least one vertebral level.
Interpretation
135° neck shaft angle resulted in maximum total horizontal range of motion both at
30° and 60° scaption regardless of retroversion angles. 135° neck shaft angle also
reduced the chances of scapular impingement. Decrease in retroversion angle resulted
in more amount of internal rotation behind the back.
Keywords
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References
- The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design.J. Bone Joint Surg. (Br.). 1997; 79: 857-865
- Grammont reverse prosthesis: design, rationale, and biomechanics.J. Shoulder Elbow Surg. 2005; 14: 147s-161s
- Neer award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.J. Shoulder Elbow Surg. 2006; 15: 527-540
- Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear.Orthopedics. 2002; 25: 129-133
- Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale.Clin. Orthop. Relat. Res. 1991; : 45-56
- Reliability of the glenoid plane.J. Shoulder Elbow Surg. 2010; 19: 414-422
- Mechanical complications of total shoulder inverted prosthesis.Rev. Chir. Orthop. Reparatrice Appar. Mot. 2002; 88: 410-414
- The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.J. Bone Joint Surg. Am. 2005; 87: 1697-1705
- Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression.J. Bone Joint Surg. Am. 1997; 79: 715-721
- Reverse total shoulder arthroplasty.J. Am. Acad. Orthop. Surg. 2009; 17: 284-295
- Delta shoulder prosthesis for rotator cuff rupture.Orthopedics. 1993; 16: 65-68
- The classic: Delta shoulder prosthesis for rotator cuff rupture.Clin. Orthop. Relat. Res. 1993; 469: 2424
- Humeral component retroversion in reverse total shoulder arthroplasty: a biomechanical study.J. Shoulder Elbow Surg. 2012; 21: 1121-1127
- Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis.J. Shoulder Elbow Surg. 2007; 16: S9-S12
- Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors.J. Bone Joint Surg. Am. 2008; 90: 2606-2615
- Evaluation of abduction range of motion and avoidance of inferior scapular impingement in a reverse shoulder model.J. Shoulder Elbow Surg. 2008; 17: 608-615
- Effect of deltoid tension and humeral version in reverse total shoulder arthroplasty: a biomechanical study.J. Shoulder Elbow Surg. 2012; 21: 483-490
- Determining humeral retroversion with computed tomography.J. Bone Joint Surg. Am. 2002; 84-a: 1753-1762
- The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders.J. Bone Joint Surg. Am. 1992; 74: 491-500
- Prosthetic component relationship of the reverse Delta III total shoulder prosthesis in the transverse plane of the body.J. Shoulder Elbow Surg. 2008; 17: 602-607
- A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty.Arthroscopy. 1999; 15: 56-66
- Scapular notching in reverse shoulder arthroplasty.J. Shoulder Elbow Surg. 2008; 17: 925-935
- Scapular notching in reverse shoulder arthroplasty: is it important to avoid it and how?.Clin. Orthop. Relat. Res. 2011; 469: 2512-2520
- Excentered scapulohumeral osteoarthritis.Rev. Chir. Orthop. Reparatrice Appar. Mot. 2007; 93: 37-94
- Recent experience in total shoulder replacement.J. Bone Joint Surg. Am. 1982; 64: 319-337
- Analysis of a retrieved Delta III total shoulder prosthesis.J. Bone Joint Surg. (Br.). 2004; 86: 1187-1191
- Biomechanical relevance of glenoid component positioning in the reverse Delta III total shoulder prosthesis.J. Shoulder Elbow Surg. 2005; 14: 524-528
- Biomechanical effects of humeral neck–shaft angle and subscapularis integrity in reverse total shoulder arthroplasty.J. Shoulder Elbow Surg. 2014; 23: 1091-1098
- Retroversion of the proximal humerus in relationship to prosthetic replacement arthroplasty.J. Shoulder Elbow Surg. 1995; 4: 286-289
- Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions.J. Shoulder Elbow Surg. 2001; 10: 17-22
- Three-dimensional analysis of the proximal part of the humerus: relevance to arthroplasty.J. Bone Joint Surg. Am. 2000; 82-a: 1594-1602
- An evaluation of the relationships between reverse shoulder design parameters and range of motion, impingement, and stability.J. Shoulder Elbow Surg. 2009; 18: 734-741
- Debridement of degenerative, irreparable lesions of the rotator cuff.J. Bone Joint Surg. Am. 1995; 77: 857-866
- Reverse total shoulder arthroplasty.Clin. Anat. 2009; 22: 172-182
- Reverse total shoulder arthroplasty for the treatment of defect arthropathy.Oper. Orthop. Traumatol. 2005; 17: 1-24
- Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement.J. Bone Joint Surg. Am. 2007; 89: 588-600
- Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive and non repairable cuff rupture.in: Walch G. Boileau P. Mole D. Shoulder prosthesis: two to ten year follow. 2001: 247-252
- Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders.J. Bone Joint Surg. (Br.). 2004; 86: 388-395
- Complex and revision in shoulder surgery.in: Warner J.P. Iannotti J.P. Latow E.L. The Reversed Prosthesis. Lippincott, Williams & Wilkins, Philadelphia2005: 497-513
- Biometry.William H. Freeman, New York1995
- Effect of humeral component version on impingement in reverse total shoulder arthroplasty.J. Shoulder Elbow Surg. 2011; 20: 652-658
- The relationship between motion of the shoulder and the stated ability to perform activities of daily living.J. Bone Joint Surg. Am. 1998; 80: 41-46
- Delta 3 reversed prosthesis for osteoarthritis with massive rotator cuff tear: long term results (>5 years), in.2000: 253-259
- Reverse total shoulder arthroplasty: a review of results according to etiology.J. Bone Joint Surg. Am. 2007; 89: 1476-1485
- Effect of coracoacromial ligament resection on glenohumeral stability under active muscle loading in an in vitro model.Arthroscopy. 2008; 24: 1258-1264
- Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis.J. Bone Joint Surg. Am. 2005; 87: 1476-1486
- A dynamic shoulder model: reliability testing and muscle force study.J. Biomech. 1995; 28: 489-499
- The SMR reverse shoulder prosthesis in the treatment of cuff-deficient shoulder conditions.J. Shoulder Elbow Surg. 2009; 18: 622-626
Article Info
Publication History
Published online: October 21, 2015
Accepted:
June 24,
2015
Received:
November 24,
2014
Footnotes
☆No author or related institute has received any financial benefit from research in this study. The authors report no conflict of interest.
Identification
Copyright
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
