Background: Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this 2-part study was to systematically review each of the most common complications of RSA, limiting each search to publications in 2010 or later. In this part (part I), we examined (1) scapular notching (SN), (2) periprosthetic infection (PJI), (3) mechanical failure (glenoid or humeral component), and (4) neurologic injury (NI).
Methods: Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Overall, 113 studies on SN, 62 on PJI, 34 on mechanical failure, and 48 on NI were included in our reviews. Univariate analysis was performed with the χ or Fisher exact test.
Results: The Grammont design had a higher SN rate vs. all other designs combined (42.5% vs. 12.3%, < .001). The onlay humeral design had a lower rate than the lateralized glenoid design (10.5% vs. 14.8%, < .001). The PJI rate was 2.4% for primary RSA and 2.6% for revision RSA. The incidence of glenoid and humeral component loosening was 2.3% and 1.4%, respectively. The Grammont design had an increased NI rate vs. all other designs combined (0.9% vs. 0.1%, = .04).
Conclusions: Focused systematic reviews of the recent literature with a large volume of RSAs demonstrate that with the use of non-Grammont modern prosthesis designs, complications including SN, PJI, glenoid component loosening, and NI are significantly reduced compared with previous studies. As the indications for RSA continue to expand, it is imperative to accurately track the rates and types of complications to justify its cost and increased indications.
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http://dx.doi.org/10.1016/j.jseint.2020.07.017 | DOI Listing |
J Clin Orthop Trauma
March 2025
Department of Orthopaedics, Woodend Hospital, Aberdeen, AB15 6XS, UK.
Reverse shoulder arthroplasty (RSA) has witnessed a significant advancement with the introduction of lateralisation techniques, aiming to enhance shoulder function and implant durability. Traditional medialised designs, following Grammont's principles, have encountered challenges such as scapular notching, reduced rotational strength, and instability. In contrast, lateralisation methods, which reposition the joint center of rotation laterally on the glenoid, humerus, or both, seek to improve deltoid leverage, optimize the rotator cuff muscles' length-tension relationship, and enhance joint stability.
View Article and Find Full Text PDFJBJS Rev
January 2025
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, Florida.
Background: Reverse shoulder arthroplasty (RSA) is increasingly used in the treatment of proximal humerus fractures (PHFs) with reliable clinical improvement. Lateralized RSA implants have conferred superior outcomes compared with the original Grammont design in patients with nontraumatic indications. However, in the setting of a PHF, lateralized components can place increased tension across the tuberosity fracture site and potentially compromise tuberosity healing and outcomes.
View Article and Find Full Text PDFCurr Rev Musculoskelet Med
January 2025
Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Purpose Of Review: With the growing popularity and broadening indications for Reverse Shoulder Arthroplasty (RSA), increasing modularity in design and adjustments to each component can enhance postoperative range of motion (ROM), thus expanding treatment capabilities. This review outlines the advancements developed to optimize ROM through modifications in glenoid and humeral components and the integration of computational tools for surgical planning.
Recent Findings: Enhancements in glenoid component design aim to mitigate complications like scapular notching and improve ROM, particularly in abduction and external rotation.
Curr Rev Musculoskelet Med
December 2024
Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Ave MU-320W, San Francisco, CA, 94143, USA.
Purpose Of The Review: There have been tremendous modifications to the humeral component since Paul Grammont first introduced the reverse total shoulder arthroplasty in 1985. The purpose of this article is to review historical design features and their drawbacks and to summarize the clinical outcomes of modern designs.
Recent Findings: Decreasing the neck-shaft angle and increasing humeral lateralization have helped address problems of scapular notching and limited internal and external rotation that were common with traditional designs.
Shoulder Elbow
September 2024
R & D Shoulder Reconstruction, DePuySynthes, Raynham, MA, USA.
Since the original Grammont design of a reverse shoulder arthroplasty there has been a trend to decrease inclination angle from 155° to 145 or 135°. Furthermore, lateralization on the glenoid side has been advocated. These changes decrease the risk for impingement between humerus and the inferior part of the glenoid (notching).
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