Reverse shoulder arthroplasty with alternate scapular line yielded improvements in glenoid bone loss

Derek J. Cuff

NEW YORK — Reverse shoulder arthroplasty performed with an alternate scapular line baseplate orientation yielded clinical improvements among patients with glenoid bone loss, according to results presented here.

Perspective from T. Bradley Edwards, MD

Derek J. Cuff, MD, and colleagues collected American Shoulder and Elbow Surgeons and simple shoulder test (SST) scores, digital range of motion measurements and patient satisfaction among 71 patients with glenoid bone loss who underwent reverse shoulder arthroplasty with an alternate scapular line baseplate orientation. Clinical and radiographic results were collected at 2-years postoperatively and at patient’s last recorded follow-up after a minimum of 60 months, according to Cuff.

“Our ASES scores showed significant improvements at the 2-year point that was maintained at final follow-up,” Cuff said in his presentation at the ASES Annual Meeting. “With respect to the SST scores, improvements were shown at the 2-year point and no drop off at final follow-up.”

He added patients had improvements in forward elevation and external rotation at 2-years postoperatively; however, Cuff noted no change or improvement in internal rotation from preoperative status to 2-year postoperative status.

“With respect to patient satisfaction at the 2-year point, 93% of the patients were satisfied and at the final follow-up point, 92% were satisfied with the results,” Cuff said.

Cuff noted radiographic results showed no evidence of scapular notching at 2 years, while 7% of patients had radiographic evidence of scapular notching at final follow-up. Patients had a complication rate of 7%, according to Cuff.

“To date, we’ve had no mechanical failures of the baseplate using this technique,” Cuff said. “Two of the baseplates have been graded at risk with radiolucencies around the center screw and peripheral screws, but they have not failed to date.” – by Casey Tingle

Reference:

Cuff DJ, et al. Paper 39. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.

Disclosure: Cuff reports he is a paid consultant and paid presenter or speaker for DJ Orthopaedics and Ignite Orthopaedics.

Perspective

T. Bradley Edwards, MD

Glenoid bone loss presents a challenge when performing reverse shoulder arthroplasty in both the primary and revision scenarios. Traditional treatment options have included autograft with its requisite donor site morbidity, allograft with risk of graft resorption and specialized implants with associated increased costs.

Derek Cuff, MD, and colleagues present yet another treatment option in their study “midterm outcomes of reverse shoulder arthroplasty using the alternate scapular line baseplate orientation for glenoid bone loss.” The investigators’ technique involves placing the reverse glenoid component in an anteverted position to take advantage of the pillar of bone where the scapular spine meets the scapular body. Using this technique in 71 patients, they avoided the need for bone graft or specialized implants. The investigators demonstrated high patient satisfaction and improved clinical outcomes at 2- and 5-year follow-up. Perhaps more importantly, the investigators did not observe any mechanical failures at minimum 5-year follow-up.

Based on this data, I believe use of the alternate scapular line for baseplate orientation represents an excellent alternative to more traditional strategies for dealing with glenoid bone loss in reverse shoulder arthroplasty.

T. Bradley Edwards, MD

Attending shoulder surgeon

Fondren Orthopedic Group

Texas Orthopedic Hospital

Houston

Disclosures: Edwards reports he is a consultant for DJO and Smith & Nephew Endoscopy and receives royalties from DJO and Wright Medical.

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Reverse shoulder arthroplasty with alternate scapular line yielded improvements in glenoid bone loss

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