A dual-cup reverse shoulder replacement improves impingement-free motion

Q4 Medicine
Rayan Alabsi BS, MS , Tejasvi Subramanya BS, MS , Michael G. Livesey MD , Logan C. Kolakowski MD , Subham Badhyal PhD , Kevin Aroom MS, PE , Li-Qun Zhang PhD , Martha O. Wang PhD , Mohit N. Gilotra MD, MS
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引用次数: 0

Abstract

Background

Advances in reverse shoulder arthroplasty (RSA) design have improved functional outcomes, which approach those of the anatomic total shoulder arthroplasty in certain patients. However, restoration of motion, especially functional internal rotation (IR), remains a concern following RSA. A novel dual-cup RSA design was developed to improve impingement-free range of motion. The passive motion of the dual-cup RSA is compared to that of a commercially available RSA design in a cadaveric model.

Methods

Five fresh-frozen cadaveric upper-extremity specimens were included in the study. The scapula was rigidly fixed, allowing for isolation of glenohumeral joint motion. The novel dual-cup RSA design was tested with and without a flanged component. The dual-cup has an outer diameter of 36 mm, articulates with a 32 + 4 mm glenosphere, and provides 6 mm of glenoid lateralization. A 32 + 4 mm lateralized glenosphere and a 36 + 6 mm lateralized glenosphere served as controls. Measurements of motion were performed using an electromagnetic tracking device and modes of impingement were recorded. An analysis of variance test was performed with a post-hoc Tukey test to compare the relative changes in range of motion among groups.

Results

The dual-cup (without flange) design improved external rotation at 0° abduction by 20.9° and improved IR by 11.5° compared to the 32 + 4 mm control (P < .01). In 90° abduction, the dual-cup improved external rotation by 11.9° compared to the 32 + 4 mm control, a significant improvement relative to the 36 + 6 mm control (P < .05). The dual-cup improved functional IR by 12.4° relative to the 32 + 4 mm control, a significant improvement relative to the 36 + 6 mm control (P < .05). The dual-cup did not significantly improve IR at 45° or 90° abduction compared to control models. Humeral component impingement on the glenoid was not observed at any end-range of motion in the implant with the flanged design.

Discussion

The dual-cup design improves all rotational motions relative to control models except IR with an abduction angle reaching or exceeding 45°. The dual-cup design improves impingement free motion, including functional IR, without additional lateralization in this study. The dual-dup with flange design eliminates impingement of the humeral cup on the glenoid neck without significantly affecting most motions relative to control models.
双杯反向肩关节置换术改善无碰撞运动
背景:反向肩关节置换术(RSA)设计的进步改善了功能结果,在某些患者中接近解剖性全肩关节置换术。然而,运动恢复,特别是功能性内旋(IR),仍然是RSA术后关注的问题。开发了一种新型双杯RSA设计,以提高无碰撞运动范围。在尸体模型中比较了双杯RSA的被动运动与市售RSA设计。方法选取5例新鲜冷冻尸体上肢标本进行研究。肩胛骨牢固固定,可隔离肩关节活动。对新型双杯RSA设计进行了带法兰组件和不带法兰组件的测试。双杯外径为36毫米,关节盂为32 + 4毫米,关节盂外侧为6毫米。一个32 + 4mm的侧化glenosphere和一个36 + 6mm的侧化glenosphere作为对照。使用电磁跟踪装置进行运动测量,并记录撞击模式。采用事后Tukey检验进行方差分析,比较各组之间运动范围的相对变化。结果与32 + 4 mm对照组相比,双杯(无凸缘)设计使外展0°时的外旋提高20.9°,IR提高11.5°(P <;. 01)。在90°外展时,与32 + 4 mm对照相比,双杯改善了11.9°的外旋,与36 + 6 mm对照相比有显著改善(P <;. 05)。相对于32 + 4 mm的控制,双杯的功能IR改善了12.4°,相对于36 + 6 mm的控制有了显著的改善(P <;. 05)。与对照模型相比,双杯在45°或90°外展时没有显著改善IR。在带法兰设计的植入物的任何末端运动范围内均未观察到肱骨组件对肩关节的撞击。双杯设计改善了相对于控制模型的所有旋转运动,除了IR外,外展角达到或超过45°。在本研究中,双杯设计改善了无撞击自由运动,包括功能性IR,而无需额外的侧化。带凸缘设计的双关节套消除了肱骨杯对肩胛颈的撞击,而不会显著影响相对于控制模型的大多数运动。
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来源期刊
Seminars in Arthroplasty
Seminars in Arthroplasty Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
104
期刊介绍: Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.
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