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Glenoid lateralization and subscapularis repair are independent predictive factors of improved internal rotation after reverse shoulder arthroplasty

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Abstract

Purpose

Reverse shoulder arthroplasty (RSA) has shown improvement in clinical outcomes for various conditions, although some authors expressed concern about the restoration of active internal rotation (AIR). The current study assesses preoperative and intraoperative predictive factors of AIR in patients having a Grammont-style RSA with a minimum five year follow-up.

Methods

We conducted a retrospective multicentric study, including patients operated on with a 155° Grammont-style RSA for cuff-related pathology or primary osteoarthritis with posterior subluxation or an associated cuff tear. Patients were clinically evaluated at a minimum of five year follow-up. Patients with previous surgery or those who had a tendon transfer with the RSA were excluded. Demographic parameters, BMI, preoperative notes, and operative reports were obtained from medical records. AIR was graded according to the constant score system from 0 to 10.

Results

A total of 280 shoulders in 269 patients (mean age at surgery, 74.9 ± 5.9 years) met the inclusion criteria and were analyzed. The average follow-up was 8.1 years (range, 5–16 years). Overall, AIR increased from 4.2 (SD 2.5, range 0 to 10) preoperatively to 5.9 (SD 2.6, range 0 to 10) at final follow-up. At the last follow-up, AIR increased in 56% of cases, was unchanged in 26% and decreased in 18%. In 188 shoulders (67%), internal rotation was functional and allowed patients to reach the level of L3 or higher. Multivariable linear regression found the following preoperative clinical factors predictive of worse AIR after RSA: male gender (ß = −1.25 [−2.10; −0.40]; p = 0.0042) and higher values of BMI (ß = −0.085 [−0.17; −0.0065]; p = 0.048). Two surgical factors were associated with better AIR after RSA: glenoid lateralization with BIO-RSA technique (ß = 0.80 [0.043; 1.56]; p = 0.039) and subscapularis repair (ß = 1.16 [0.29; 2.02]; p = 0.0092).

Conclusions

With a mean of eight year follow-up (5 to 16 years), internal rotation was functional (≥ L3 level) in 67% of operated shoulders after Grammont-style RSA; however, two patients out of ten had decreased AIR after surgery. Male patients and those with higher BMIs had worse AIR, with glenoid lateralization (using the BIO-RSA technique) and subscapularis repair, as they are predictive of increased AIR after RSA.

Level of evidence

Case series, Level IV

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Data availability

Data is available upon reasonable request and in respect of applicable privacy regulations.

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Acknowledgements

We are grateful to the surgeons who participated in the data collection of some of their cases: Nicolas Bonnevialle, Nicolas Brassart, Philippe Clavert, Philippe Collin, Nicolas Jacquot, Gregory Moineau, Daniel Molé, and Christophe Trojani.

Sylvain Teissier and Agnes Uranovicz for their help in the management of this study.

Sophie Plantier for her help with retrieving data in medical records.

Author information

Authors and Affiliations

  1. ICR-Institut de Chirurgie Réparatrice-Locomoteur et Sports, Groupe Kantys, 7 avenue Durante, 06000, Nice, France

    Mikaël Chelli, Michel Azar & Pascal Boileau

  2. Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France

    Gilles Walch & Lionel Neyton

  3. Clinique du parc Lyon, 155, boulevard Stalingrad, 69006, Lyon, France

    Christophe Lévigne

  4. Service d’Orthopédie Traumatologie, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, Chambray-les-, Tours, France

    Luc Favard

Authors
  1. Mikaël Chelli
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  2. Gilles Walch
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  3. Michel Azar
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  4. Lionel Neyton
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  7. Pascal Boileau
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Contributions

• Study conception and design: all authors

• Material preparation and data analysis: MC

• Data collection: all authors

• Writing: MC

• Reviewing: all authors

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mikaël Chelli.

Ethics declarations

Ethics approval and consent to participate

Institutional review board: IRB ICR-SR-10-02. This study was performed in line with the principles of the Declaration of Helsinki.

Informed consent was obtained from all individual participants included in the study.

Competing interests

Gilles Walch, Lionel Neyton, Christophe Lévigne, Luc Favard, and Pascal Boileau are paid consultants or have been paid consultants for Tornier. Other authors do not have conflicts of interest related to this manuscript.

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Chelli, M., Walch, G., Azar, M. et al. Glenoid lateralization and subscapularis repair are independent predictive factors of improved internal rotation after reverse shoulder arthroplasty. International Orthopaedics (SICOT) 48, 127–132 (2024). https://doi.org/10.1007/s00264-023-06048-6

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  • DOI: https://doi.org/10.1007/s00264-023-06048-6

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