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. 2025 Jan 16;14(2):546.
doi: 10.3390/jcm14020546.

Mid-Term Outcomes of a Rectangular Stem Design with Metadiaphyseal Fixation and a 135° Neck-Shaft Angle in Reverse Total Shoulder Arthroplasty

Yacine Ameziane  1   2 , Laurent Audigé  3   4 , Christian Schoch  5 , Matthias Flury  6 , Hans-Kaspar Schwyzer  1 , Alessandra Scaini  1 , Emanuele Maggini  1 , Philipp Moroder  1
Affiliations

Mid-Term Outcomes of a Rectangular Stem Design with Metadiaphyseal Fixation and a 135° Neck-Shaft Angle in Reverse Total Shoulder Arthroplasty

Yacine Ameziane et al. J Clin Med. .

Abstract

Background/Objectives: Classical reverse shoulder arthroplasty (RSA) with a high neck-shaft angle (NSA) of 155° has shown satisfactory outcomes. However, newer RSA designs aim to improve results by modifying the stem design. This study evaluates the 5-year outcomes of a stem design featuring a rectangular metadiaphyseal fixation and a 135° NSA. Methods: This prospective bicentric case series included and longitudinally followed up patients that were treated for cuff arthropathy, massive irreparable rotator cuff tears, or eccentric osteoarthritis using a non-cemented rectangular metadiaphyseal fixation stem with a 135° NSA (Univers Revers, Arthrex, Naples, FL, USA). Subjective and objective functional outcome scores (Constant-Murley Score (CS), Shoulder Pain and Disability Index (SPADI), and Subjective Shoulder Value (SSV)), range of motion (ROM), radiographic outcome, adverse events, complications, and quality of life were investigated. Results: This study enrolled 132 patients (59% female, mean age 75 years, SD 6). At the 5-year follow-up, subjective and objective outcomes significantly improved compared to baseline: CS (32.9 to 71.7, p < 0.001), SPADI (38.7 to 86.2, p < 0.001), and SSV (43.0 to 84.1, p < 0.001). ROM improved in flexion (80° to 142.4°, p < 0.001), abduction (71.5° to 130.2°, p < 0.001), internal rotation (p < 0.001), internal rotation at 90° abduction (12.7° to 45.0°, p < 0.001), and abduction strength (0.8 kg to 5.2 kg, p < 0.001). External rotation remained unchanged (32.1° to 32.0°, p = 0.125), but external rotation at 90° abduction improved (20.9° to 52.7°, p < 0.001). No signs of implant migration, subsidence, shift, tilt, alignment loss, or wear were observed, but scapular bone spur formation (11%), scapular notching grade 1 (10%), bone resorption (10%), and partial humeral radiolucent lines (1%) were reported. Conclusions: Rectangular stems with metadiaphyseal fixation and a 135° neck-shaft angle in RSA consistently improve shoulder function, showing no aseptic loosening and minimal radiological changes at 5 years.

Keywords: humeral stem fixation; inclination; reverse total shoulder arthroplasty; shoulder.

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Conflict of interest statement

Y.A., L.A., E.M., C.S., A.S., and H.-K.S: these authors declare no conflicts of interest. P.M. and M.F.: these authors are consultants for Arthrex Inc. (Naples, Florida, United States of America). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Example at the five-year follow-up after reverse shoulder arthroplasty with 135° NSA and a cementless metadiaphyseal fixation stem (Univers Revers, Arthrex, Naples, FL).
Figure 2
Figure 2
Flow chart—enrolled patients and follow-up.
Figure 3
Figure 3
Signs of diaphyseal bone resorption at the 5-year follow-up after RTSA implantation.
Figure 4
Figure 4
Reverse shoulder arthroplasty at the 5-year follow-up showing grade 1 scapular notching and consecutive scapular bone spur formation.
Figure 5
Figure 5
Kaplan–Meier curve: implant survival rate, including number at risk at specific time points. Numbers in parentheses indicate revisions conducted prior to the 2-year follow-up and at the 2- and 5-year follow-ups.
Figure 6
Figure 6
Longitudinal changes of subjective and objective outcome parameters and ROM from baseline to the five-year follow-up. (a) Longitudinal changes of subjective quality of life parameters from baseline to five-year follow-up. (b) Longitudinal changes of the SPADI, the Constant-Murley Score and the Subjective Shoulder-Value from baseline to five-year follow-up. (c) Longitudinal changes of ROM from baseline to five-year follow-up. (d) Longitudinal changes of ROM in terms of maximal internal rotation heights from baseline to five-year follow-up.
Figure 6
Figure 6
Longitudinal changes of subjective and objective outcome parameters and ROM from baseline to the five-year follow-up. (a) Longitudinal changes of subjective quality of life parameters from baseline to five-year follow-up. (b) Longitudinal changes of the SPADI, the Constant-Murley Score and the Subjective Shoulder-Value from baseline to five-year follow-up. (c) Longitudinal changes of ROM from baseline to five-year follow-up. (d) Longitudinal changes of ROM in terms of maximal internal rotation heights from baseline to five-year follow-up.
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