scholarly journals Assessment of Shoulder Mobility and Stability in Reverse Total Shoulder Arthroplasty: a Sensor Perspective

10.29007/dlq8 ◽  
2019 ◽  
Author(s):  
Matthias Verstraete ◽  
Michael Conditt ◽  
Moby Parsons ◽  
Joseph Decerce ◽  
Gordon Goodchild ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Clinical Value ◽  
Load Sensor ◽  
Shoulder Arthroplasties ◽  
Reverse Total Shoulder

In reverse total shoulder arthroplasty stability is primarily controlled by the soft-tissue constraints rather than the congruency of the articulating surfaces. However, assessing the tension in these stabilizing structures currently remains highly subjective intra- operatively. In an attempt to quantify this feel during surgery, an intra-articular load sensor is introduced in this paper. In an in-vitro setting, the load sensor was used in eight reverse total shoulder arthroplasties on full torso specimens. The specimens were mounted on an inclined chair, such that the scapula could freely move to mimic surgical conditions. The resulting load vectors were captured through the range of motion under three different conditions, subjectively categorized by the surgeon as having a low, normal and high tightness. In neutral rotation and under a subjectively optimal condition assessed as neither too tight nor too loose, glenohumeral loads in the range of 10-20lbs were observed. For the same subjectively assessed optimal shoulder, loads up to 30lbs were observed under maximum internal/external humeral rotation. This contrasts the subjectively assessed loose and tight conditions, where lower resp. higher loads were observed that additionally affected the range of motion. On the other hand, stability was potentially missing under loose conditions as no increase in load was observed near the limits of the range of motion, indicating the lack of soft tissue restraint. In conclusion, this series of in- vitro experiments has shown the relevance and potential clinical value of assessing a shoulder’s stability and mobility using intra-articular load measurements during the trialing phase.

Effect of deltoid volume on range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions

2020 ◽  
pp. 175857322092504
Author(s):  
Samuel G McClatchy ◽  
Griffin M Heise ◽  
William M Mihalko ◽  
Frederick M Azar ◽  
Richard A Smith ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Deltoid Muscle ◽  
Reverse Total Shoulder Arthroplasty ◽  
Shoulder Range Of Motion ◽  
Patient Reported ◽  
Reverse Total Shoulder

Background Deltoid muscle function is paramount to the success of reverse total shoulder arthroplasty. The purpose of this study was to investigate the role of deltoid volume on shoulder range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions. Methods Retrospective review of records identified 107 patients who met inclusion criteria. The rotator cuff integrity was evaluated by two musculoskeletal-trained radiologists. Volumetric deltoid measurements were calculated from preoperative computed tomography or magnetic resonance imaging scans. Satisfactory outcomes were defined as forward elevation of at least 135°, external rotation of at least 35°, and American Shoulder and Elbow Surgeons and Single Assessment Numerical Evaluation scores of at least 70. Results Mean total deltoid muscle volume was significantly higher in patients with satisfactory forward elevation (57.8 ± 18.1 cm³) versus unsatisfactory forward elevation (48.6 ± 19.5 cm³) (p = 0.013). When separated by rotator cuff integrity, total deltoid volume was significantly higher (p = 0.030) in patients who achieved satisfactory forward elevation in the rotator cuff-deficient group but not the rotator cuff-intact group (p = 0.533). Discussion Preoperative deltoid volume directly correlated with achieving satisfactory forward elevation after reverse total shoulder arthroplasty in rotator cuff-deficient conditions and may be one factor in determining the ability to achieve satisfactory outcomes in the rotator cuff-deficient patient.

Influence of Humeral Version and Deltoid Tension on Glenohumeral Kinematics After Reverse Total Shoulder Arthroplasty

2011 ◽  
Author(s):  
Heath B. Henninger ◽  
Alexej Barg ◽  
Robert Z. Tashjian ◽  
Robert T. Burks ◽  
Kent N. Bachus ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Outcome Measures ◽  
Shoulder Arthroplasty ◽  
Surgical Intervention ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
And Function ◽  
Reverse Total Shoulder

Reverse total shoulder arthroplasty (rTSA) is used to improve pain and function in arthritic, rotator cuff deficient shoulders. Surgical intervention is considered successful if range of motion and stability of the joint is maximized and force to abduct the arm is minimized. Implant hardware positioning may affect these outcome measures.

scholarly journals Does Humeral Component Version Affect Range of Motion and Clinical Outcomes in Reverse Total Shoulder Arthroplasty? A Systematic Review

2021 ◽  
Vol 10 (24) ◽  
pp. 5745
Author(s):  
Shivan S. Jassim ◽  
Lukas Ernstbrunner ◽  
Eugene T. Ek
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Functional Scores ◽  
Outcome Scores ◽  
Reverse Total Shoulder

Background: Prosthesis selection, design, and placement in reverse total shoulder arthroplasty (RTSA) affect post-operative results. The aim of this systematic review was to evaluate the influence of the humeral stem version and prosthesis design (inlay vs. onlay) on shoulder function following RTSA. Methods: A systematic review of the literature on post-operative range of motion (ROM) and functional scores following RTSA with specifically known humeral stem implantations was performed using MEDLINE, Pubmed, and Embase databases, and the Cochrane Library. Functional scores included were Constant scores (CSs) and/or American Shoulder and Elbow Surgeons (ASES) scores. The patients were organised into three separate groups based on the implanted version of their humeral stem: (1) less than 20° of retroversion, (2) 20° of retroversion, and (3) greater than 20° of retroversion. Results: Data from 14 studies and a total of 1221 shoulders were eligible for analysis. Patients with a humeral stem implanted at 20° of retroversion had similar post-operative mean ASES (75.8 points) and absolute CS (68.1 points) compared to the group with humeral stems implanted at less than 20° of retroversion (76 points and 62.5 points; p = 0.956 and p = 0.153) and those implanted at more than 20° of retroversion (73.3 points; p = 0.682). Subjects with humeral stem retroversion at greater than 20° tended towards greater active forward elevation and external rotation compared with the group at 20° of retroversion (p = 0.462) and those with less than 20° of retroversion (p = 0.192). Patients with an onlay-type RTSA showed statistically significantly higher mean post-operative internal rotation compared to patients with inlay-type RTSA designs (p = 0.048). Other functional scores and forward elevation results favoured the onlay-types, but greater external rotation was seen in inlay-type RTSA designs (p = 0.382). Conclusions: Humeral stem implantation in RTSA at 20° of retroversion and greater appears to be associated with higher post-operative outcome scores and a greater range of motion when compared with a retroversion of less than 20°. Within these studies, onlay-type RTSA designs were associated with greater forward elevation but less external rotation when compared to inlay-type designs. However, none of the differences in outcome scores and range of motion between the humeral version groups were statistically significant.

scholarly journals Is reverse total shoulder arthroplasty (rTSA) more advantageous than anatomic TSA (aTSA) for osteoarthritis with intact cuff tendon? A systematic review and meta-analysis

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Hyojune Kim ◽  
Chul-Ho Kim ◽  
Minsoo Kim ◽  
Wonsun Lee ◽  
In-Ho Jeon ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Revision Rate ◽  
Meta Analysis ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Functional Scores ◽  
Reverse Total Shoulder ◽  
Glenoid Loosening

Abstract Purpose We aimed to compare the outcomes and complications of anatomical shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) for primary glenohumeral osteoarthritis with intact cuff tissue. Materials and methods The MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 2, 2021 using the PRISMA guidelines. Studies were included if they directly compared aTSA and rTSA for treating primary glenohumeral arthritis. A meta-analysis was performed using six studies that compared radiologic outcomes, functional scores, and range of motion (ROM). All the data were pooled using a random-effects model. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, while continuous data were analyzed using mean differences with 95% CIs. Results Two independent researchers reviewed 1,061 studies. Six studies met the inclusion criteria. The range of motion, especially external rotation, was better for aTSA than for rTSA (MD = − 10.28, 95% CI: − 16.69 to − 3.88, P = 0.002). Functional scores showed no difference between aTSA and rTSA. Glenoid loosening (OR = 0.17, 95% CI: 0.06–0.50, P = 0.001) was more common with aTSA, and scapula notching (OR = 10.63, 95% CI: 1.73–65.27, P = 0.01) with rTSA. In the mid-term follow-up, the overall revision rate showed no difference between aTSA and rTSA, with a pooled OR of 0.33 (95% CI: 0.07–1.57, P = 0.16). Conclusion A better ROM was achieved after aTSA than after rTSA. There was no difference in the revision rate at mid-term follow-up between aTSA and rTSA. Glenoid loosening was more common with aTSA, and scapula notching with rTSA. Level of evidence: Level IV, Meta-analysis.

scholarly journals Anatomical and reverse shoulder arthroplasty utilizing a single implant system with a platform stem: A prospective observational study with midterm follow-up

2019 ◽  
Vol 12 (5) ◽  
pp. 330-337
Author(s):  
Lindsay Flynn ◽  
Matthew R Patrick ◽  
Christopher Roche ◽  
Joseph D Zuckerman ◽  
Pierre-Henri Flurin ◽  
...  
Keyword(s):  
Los Angeles ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Outcome Scores ◽  
Implant System ◽  
Reverse Total Shoulder

Background No studies compare outcomes of anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty with more than five-year follow-up. Methods A multicenter prospectively collected shoulder registry was utilized to review all patients undergoing primary anatomic total shoulder arthroplasty or primary reverse total shoulder arthroplasty with a minimum five-year follow-up utilizing a single platform stem implant system. One-hundred-ninety-one patients received an anatomic total shoulder arthroplasty and 139 patients received a reverse total shoulder arthroplasty. Patients were scored preoperatively and at latest follow-up using the simple shoulder test (SST), University of California Los Angeles (UCLA), American shoulder and elbow surgeons (ASES), Constant, and shoulder pain and disability index (SADI) scores as well as range of motion. Radiographs were evaluated for implant loosening or notching. Complications were reviewed. A Student’s two-tailed, unpaired t-test identified differences in preoperative, postoperative, and pre-to-postoperative improvements. Results Reverse total shoulder arthroplasty patients were significantly older than anatomic total shoulder arthroplasty patients. All patients demonstrated significant improvement in functional metric scores and range of motion following anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty. There was no difference in final outcome scores between anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients at midterm follow-up; however, reverse total shoulder arthroplasty patients demonstrated significantly less motion. Discussion We demonstrate equivalent outcomes with five scoring metrics at mean follow-up of 71.3 ± 14.1 months. Although postoperative scores were significantly greater than preoperative scores for both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients, significant differences in outcome scores between cohorts were not observed.

Development and Performance Evaluation of a Multi-PID Muscle Loading Driven In Vitro Active-Motion Shoulder Simulator and Application to Assessing Reverse Total Shoulder Arthroplasty

2014 ◽  
Vol 136 (12) ◽  
Author(s):  
Joshua William Giles ◽  
Louis Miguel Ferreira ◽  
George Singh Athwal ◽  
James Andrew Johnson
Keyword(s):  
Shoulder Arthroplasty ◽  
Statistical Power ◽  
Closed Loop ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Active Motion ◽  
Relevant Variable ◽  
Muscle Loading ◽  
Reverse Total Shoulder

In vitro active shoulder motion simulation can provide improved understanding of shoulder biomechanics; however, accurate simulators using advanced control theory have not been developed. Therefore, our objective was to develop and evaluate a simulator which uses real-time kinematic feedback and closed loop proportional integral differential (PID) control to produce motion. The simulator’s ability to investigate a clinically relevant variable—namely muscle loading changes resulting from reverse total shoulder arthroplasty (RTSA)—was evaluated and compared to previous findings to further demonstrate its efficacy. Motion control of cadaveric shoulders was achieved by applying continuously variable forces to seven muscle groups. Muscle forces controlling each of the three glenohumeral rotational degrees of freedom (DOF) were modulated using three independent PID controllers running in parallel, each using measured Euler angles as their process variable. Each PID controller was configured and tuned to control the loading of a set of muscles which, from previous in vivo investigations, were found to be primarily responsible for movement in the PID’s DOF. The simulator’s ability to follow setpoint profiles for abduction, axial rotation, and horizontal extension was assessed using root mean squared error (RMSE) and average standard deviation (ASD) for multiple levels of arm mass replacement. A specimen was then implanted with an RTSA, and the effect of joint lateralization (0, 5, 10 mm) on the total deltoid force required to produce motion was assessed. Maximum profiling error was <2.1 deg for abduction and 2.2 deg for horizontal extension with RMSE of <1 deg. The nonprofiled DOF were maintained to within 5.0 deg with RMSE <1.0 deg. Repeatability was high, with ASDs of <0.31 deg. RMSE and ASD were similar for all levels of arm mass replacement (0.73–1.04 and 0.14–0.22 deg). Lateralizing the joint’s center of rotation (CoR) increased total deltoid force by up to 8.5% body weight with the maximum early in abduction. This simulator, which is the first to use closed loop control, accurately controls the shoulder’s three rotational DOF with high repeatability, and produces results that are in agreement with previous investigations. This simulator’s improved performance, in comparison to others, increases the statistical power of its findings and thus its ability to provide new biomechanical insights.

scholarly journals Anatomic shoulder arthroplasty: an update on indications, technique, results and complication rates

Joints ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 72-77 ◽  
Author(s):  
Lorenzo Mattei ◽  
Stefano Mortera ◽  
Chiara Arrigoni ◽  
Filippo Castoldi
Keyword(s):  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Scientific Community ◽  
Total Shoulder Arthroplasty ◽  
Persistent Pain ◽  
Reverse Total Shoulder Arthroplasty ◽  
Complication Rates ◽  
Shoulder Replacement ◽  
Reverse Total Shoulder ◽  
Loss Of Strength

A shoulder replacement is indicated in patients affected by glenohumeral arthropathy with severely reduced range of motion, persistent pain, especially at night, and loss of strength. There is much discussion in the scientific community about the prosthetic options for these cases: hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty. We analyzed the indications for, results of, and complications associated with this kind of surgery, focusing on anatomic arthroplasty and on the concept of modularity.

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