Greiner, J Shoulder Elbow Surg 2015 - Clinical Performance of Lateralized versus Non-Lateralized Reverse Shoulder Arthroplasty: A Prospective Randomized Study
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Clinical Performance of Lateralized versus Non-Lateralized Reverse Shoulder Arthroplasty: A Prospective Randomized Study
Greiner, Perka, et al.·J Shoulder Elbow Surg·2015·149 citations
Greiner and colleagues tested whether lateralizing the center of rotation with a humeral head bone graft (BIO‑RSA) improves rotation and outcomes over a standard non‑lateralized reverse for cuff tear arthropathy.
Prospective randomized trial of 34 patients aged 65 or older, 31 followed a mean of 22 months. Supported by Tornier, which the authors state had no role in data or analysis.
Key Findings
Both groups improved, with no significant difference in any score: postoperative Constant score 61.5 standard vs 64.1 lateralized (p = 0.489).
Mean gain in active external rotation was larger with lateralization but not significant: 28° vs 18° with the arm at the side (p = 0.302) and 42° vs 33° at 90° abduction (p = 0.501).
In an additional analysis excluding 4 patients with a degenerated teres minor (27 left), lateralization gave greater external rotation gain: 42° vs 16° at the side (p = 0.038) and 60° vs 27° at 90° (p = 0.039).
In that intact teres minor subgroup, Constant, age and gender‑adjusted Constant, and DASH scores still did not differ between techniques.
On 12‑month CT, the graft healed to the glenoid in every lateralized patient, with no resorption, lysis or radiolucent lines around the pegs or screws.
CT showed acromial stress fractures in 4 patients, 2 per group, none needing further treatment. No other complications occurred.
Authors' conclusion
RSA with bony lateralization shows a trend toward improved external rotation in lateralized RSA, with a statistically significant improvement in external rotation in patients with an intact teres minor.
Greiner and colleagues tested whether lateralizing the center of rotation with a humeral head bone graft (BIO‑RSA) improves rotation and outcomes over a standard non‑lateralized reverse for cuff tear arthropathy.
Prospective randomized trial of 34 patients aged 65 or older, 31 followed a mean of 22 months. Supported by Tornier, which the authors state had no role in data or analysis.
Key Findings
Both groups improved, with no significant difference in any score: postoperative Constant score 61.5 standard vs 64.1 lateralized (p = 0.489).
Mean gain in active external rotation was larger with lateralization but not significant: 28° vs 18° with the arm at the side (p = 0.302) and 42° vs 33° at 90° abduction (p = 0.501).
In an additional analysis excluding 4 patients with a degenerated teres minor (27 left), lateralization gave greater external rotation gain: 42° vs 16° at the side (p = 0.038) and 60° vs 27° at 90° (p = 0.039).
In that intact teres minor subgroup, Constant, age and gender‑adjusted Constant, and DASH scores still did not differ between techniques.
On 12‑month CT, the graft healed to the glenoid in every lateralized patient, with no resorption, lysis or radiolucent lines around the pegs or screws.
CT showed acromial stress fractures in 4 patients, 2 per group, none needing further treatment. No other complications occurred.
Authors' conclusion
RSA with bony lateralization shows a trend toward improved external rotation in lateralized RSA, with a statistically significant improvement in external rotation in patients with an intact teres minor.