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Review
. 2021 Nov 23;13(11):e19845.
doi: 10.7759/cureus.19845. eCollection 2021 Nov.

Reverse Shoulder Arthroplasty Humeral Lateralisation: A Systematic Review

Govind Dhillon  1 , Madeline Warren  1 , Angelos Assiotis  2 , Adam Rumian  3 , Harpal S Uppal  1
Affiliations
Review

Reverse Shoulder Arthroplasty Humeral Lateralisation: A Systematic Review

Govind Dhillon et al. Cureus. .

Abstract

Different studies on reverse shoulder arthroplasty (RSA) have proposed changes to the humeral design to lateralise the humeral centre of rotation (COR), with humeral inclination to 135 or 145 from 155 degrees or to switch to onlay humeral trays from inlay design; with both having also been used in combination. There have been many studies and systematic reviews to show the difference in outcomes and complications to the variations in glenoid design but to date, there have been no systematic studies to compare different humeral inclinations for RSA implants. Searches using keywords were used in common medical search engines in a systematic fashion. The article was reviewed for the class of evidence and bias, summarised and compared in meta-analysis. Inclusion criteria included studies on adults with RSA that compared lateralised humeral implants to medialised. The search produced 349 articles; of these, we identified nine studies that met the inclusion criteria. Our review identified a total of 562 patients who had been included in studies directly comparing lateralised humerus to a more medial design. Meta-analysis showed a significantly reduced risk of scapular notching in lateralised humerus compared to the standard medialised component. The external rotation range of motion in the lateralised group was statistically significant. The improvement in scapular notching and gain in the range of motion without any apparent downside in the form of reduced patient-reported outcome measures or complications suggest a lateralised humeral component is superior to the more medialised design in RSA. A large RCT with a longer-term follow-up is needed to confirm whether there is clinically significant benefit from the lateralisation of the humerus.

Keywords: 135; 145; 155; ascend flex; centre of rotation; inlay; lateralisation; onlay; reverse shoulder arthroplasty.

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Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. PRISMA flow chart showing search strategy and outcome
Source: [19] PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Scapular notching forest plot
[23,25-26,28-31]
Figure 3
Figure 3. Constant score forest plot
[23-24,26,29-30]
Figure 4
Figure 4. American Shoulder and Elbow Surgeons shoulder score (ASES) forest plot
[24-25,27-29,31]
Figure 5
Figure 5. External rotation forest plot (1/2)
[24,26,31]
Figure 6
Figure 6. External rotation forest plot 2/2
[24-29,31]
See this image and copyright information in PMC

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