Giovanni Merolla1,2, Mauro De Cupis3, Gilles Walch4, Vincenzo De Cupis3, Elisabetta Fabbri5, Francesco Franceschi6, Claudio Ascani7, Paolo Paladini8, Giuseppe Porcellini9. 1. Shoulder and Elbow Unit, Cervesi Hospital, AUSL della Romagna, Via L. v. Beethoven 46, 47841, Cattolica, Italy. giovannimerolla@hotmail.com. 2. Biomechanics Laboratory, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy. giovannimerolla@hotmail.com. 3. Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy. 4. Centre Orthopédique Santy, Hôpital Jean Mermoz, Ramsay GDS, Lyon, France. 5. Research and Innovation Department - Rimini, AUSL della Romagna, Rimini, Italy. 6. Shoulder and Elbow Unit, Campus Bio-Medico, University of Rome, Rome, Italy. 7. Shoulder and Elbow Unit, Centro Ortopedico Traumatologico (CTO), Rome, Italy. 8. Shoulder and Elbow Unit, Cervesi Hospital, AUSL della Romagna, Via L. v. Beethoven 46, 47841, Cattolica, Italy. 9. Orthopaedic and Trauma Unit, University of Modena and Reggio Emilia, Modena, Italy.
Abstract
BACKGROUND: We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. METHODS: Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant-Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. RESULTS: RTSA were older than TSA patients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). CONCLUSION: RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.
BACKGROUND: We evaluated the pre-operative factors affecting anatomical and reverse total shoulder arthroplasty (TSA and RTSA) indications in primary osteoarthritis and compared outcomes in patients aged 70 years and older. METHODS: Fifty-eight patients received a TSA with an all-polyethylene glenoid component (APGC) or an RTSA with/without glenoid lateralization and the same curved short-stem humeral component. Active anterior and lateral elevation (AAE, ALE), internal and external rotation (IR, ER), pain, and the Constant-Murley score (CS) were recorded pre and post-operatively. Pre-operative rotator cuff (RC) fatty infiltration (FI) and modified Walch glenoid morphology were assessed. Humeral and glenoid component radiological outcomes were recorded. RESULTS: RTSA were older than TSApatients (p = 0.006), had lower pre-operative AAE (p < 0.001), ALE (p < 0.001), IR (p = 0.002), pain (p = 0.008) and CS (p < 0.001), and greater supraspinatus FI (p < 0.001). At a mean of 28.8 months, both implants yielded significantly different post-operative scores and similar complication rates. Both groups achieved similar post-operative AAE, ER, and IR; ALE was higher in TSA (p = 0.006); and AAE and ALE delta scores were higher in RTSA (p = 0.045 and p = 0.033, respectively). Radiolucent line rates were higher around the TSA APGC than the RTSA baseplate (p = 0.001). High-grade RC FI adversely affected mobility improvement. Humeral cortical thinning was significantly higher in TSA (p = 0.001). CONCLUSION: RTSA patients were older, had poorer pre-operative active mobility, and had greater RC FI than TSA. Both devices provided good mid-term clinical and ROM improvement.
Entities:
Keywords:
Anatomical; Elderly; Primary osteoarthritis; Reverse; Total shoulder arthroplasty
Authors: Giovanni Merolla; Francesco Cuoghi; George S Athwal; Ilaria Parel; Maria V Filippi; Andrea G Cutti; Elisabetta Fabbri; Antonio Padolino; Paolo Paladini; Fabio Catani; Giuseppe Porcellini Journal: Int Orthop Date: 2021-07-01 Impact factor: 3.075