Search Results (65)

Background: In reverse shoulder arthroplasty (RSA), preservation of the subscapularis (SSC) has gained attention because of its biomechanical and functional significance. However, when SSC preservation is attempted using the conventional deltopectoral (DP) approach, glenoid visualization and instrument access may be limited. The purpose of this Technical Note is to describe a modified deltopectoral exposure technique, hereafter referred to as the Margin-Shifted, Yawing, Subscapularis-Sparing, and Transitioned Lateralized Deltopectoral (MYST–LDP) approach, and to assess its feasibility in primary RSA. Methods: The MYST–LDP approach incorporates a laterally shifted incision apex, a proximally oriented curved arc (“yawing”) toward the acromion, complete preservation of the subscapularis, and a distally transitioned limb aligned with the anterior humeral axis. We describe the surgical technique and our initial experience in three consecutive primary RSA cases performed using an inlay implant system to minimize humeral lateralization and allow focused assessment of exposure geometry. Results: In all cases, the SSC was preserved without conversion to a standard DP exposure. Adequate glenoid visualization was achieved using three retractors without excessive soft-tissue tension, allowing controlled glenoid preparation and component implantation without additional exposure or conversion. No approach-related intraoperative complications were observed. Conclusions: The MYST–LDP approach is a feasible modification of the deltopectoral exposure that preserves both SSC and the deltoid while facilitating glenoid visualization and instrument alignment. This technique represents an ergonomic and tissue-preserving option within the familiar DP framework for surgeons performing SSC-preserving RSA. Further comparative and quantitative studies are warranted to determine its clinical value. Full article

Background/Objectives: Arthroscopic rotator cuff repair (ARCR) and reverse shoulder arthroplasty (RSA) are among the most commonly used surgical treatment methods. A growing number of studies assess the changes in the biomechanical and viscoelastic properties of the muscles and tendons surrounding the shoulder joint. Therefore, the aim of this study was to review the literature to determine how the biomechanical properties of the muscles surrounding the shoulder joint change as a result of ARCR and RSA, and whether MyotonPRO was used in this group of patients. Methods: A review of the international scientific literature was conducted in September 2025. The study was based on searches of the following databases: Google Scholar, PubMed, Scopus, and Web of Science. A final total of 32 articles were included in the review. Results: In this article, we have shown that ARCR and RSA procedures cause changes in the biomechanical properties of the muscles surrounding the shoulder joint. We also demonstrated that MyotonPRO has been used in this group of patients in a limited number of studies. However, the studies confirm that it is a reliable tool for examining upper limb muscles. Conclusions: This literature review demonstrates a new direction in research using MyotonPRO. Using this device in muscle testing in patients after ARCR and RSA will allow for a better understanding of the changes that occur in muscles as a result of these procedures, as research in this area is new and incomplete. Full article

Background: Reverse shoulder arthroplasty (RSA) relies on secure baseplate fixation to the glenoid. This carries a risk of suprascapular nerve (SSN) injury during peripheral screw insertion. Although fixed safe zones have been described, it remains unclear whether these scale with scapular morphometry or whether common screw positions confer differential SSN risk. Methods: Twenty cadaveric shoulders (ten pairs) were dissected. The superior safe zone (distance from the supraglenoid tubercle to SSN at the suprascapular notch) and posterior safe zone (distance from the glenoid rim to SSN at the spinoglenoid notch) were measured. Scapular dimensions (height, spine length, width) were measured. In ten shoulders, simulated RSA baseplate fixation was performed with superior screws placed at 11, 12, or 1 o’clock and posterior screws at 8, 9, or 10 o’clock. Screw lengths were based on glenoid depth. Cortical breach and SSN proximity were recorded. Linear regression assessed relationships between scapular dimensions and safe zones. Results: The superior safe zone (mean 2.9 ± 0.5 cm) significantly correlated with scapular dimensions (r = 0.78–0.86; p < 0.0001). All superior screws remained intraosseous across configurations. The posterior safe zone (1.9 ± 0.6 cm) showed no correlation. Posterior cortical breach occurred in 50% of specimens across all tested positions and was associated with smaller scapular spine length (p = 0.027). No significant difference in SSN proximity was observed between posterior screw positions. Conclusions: Scapular dimensions predict the superior, but not posterior, safe zone. Scapulae with shorter spine lengths demonstrated increased risk of posterior cortical breach, independent of screw position. These findings establish anatomical scalability of the superior safe zone and suggest that scapular morphometry may inform preoperative RSA planning; however, prospective validation is needed before routine clinical implementation. Full article

Background/Objectives: Periprosthetic humeral fractures (PF) after reverse total shoulder arthroplasty (RSA) are expected to increase. This study investigated PF after RSA with short stems and reported outcomes. Methods: A total of 165 patients underwent short-stem RSAs between 2014 and 2023. Among them, patients who developed postoperative PFs were identified and classified by fracture location and stem loosening. Operative data, complications, and bone union time were analyzed. Clinical outcomes before injury and at final follow-up were evaluated. Results: PF occurred in 5/165 patients (3.0%). Based on our classification, four had type B1 fractures and one had a type B3 fracture. All underwent revision RSA (Re-RSA) with conversion to long-stem implants. Bone union was achieved in four patients, while one patient experienced infection without union. Among the four patients without complications, mean shoulder flexion declined from 138° pre-injury to 103°, abduction from 118° to 95°, external rotation from 37° to 31°, the American Shoulder and Elbow Surgeons (ASES) score from 82.0 to 68.7, Constant Score from 67 to 43, while the Visual Analog Scale (VAS) pain score increased from 1.7 to 2.6. Conclusions: All five cases of PF following short-stem RSA were stem-level (type B) fractures. All patients underwent Re-RSA using long-stem conversion. Four patients had bone union. Clinical outcomes at one year postoperatively had deteriorated mildly compared to pre-fracture. However, this change was not statistically significant. One patient had a postoperative infection, and bone union was not observed. This study indicates the need for caution regarding postoperative infections after RSA. Full article

Background/Objectives: In the elderly population, thoracic kyphosis often progresses with age, leading to secondary postural adaptations including scapular protraction, internal rotation, and anterior tilt. These alterations can potentially compromise shoulder biomechanics, particularly in patients undergoing reverse shoulder arthroplasty (RSA). The purpose of this study was to evaluate the relationship between thoracic sagittal alignment, quantified by the Cobb angle, and scapular internal rotation (SIR) assessed on CT scans in patients scheduled for RSA. Methods: A retrospective study was conducted on 164 patients who underwent RSA between 2016 and 2024 at a single tertiary referral center. Sagittal thoracic kyphosis was assessed using the Cobb angle measured on preoperative chest radiographs. SIR and anterior scapular tilt were evaluated using preoperative CT scans. Patients were divided into three groups according to the Cobb angle: Group A (≤36°), Group B (>36–46°), and Group C (≥47°). Statistical analysis was performed using the Spearman correlation coefficient and Kruskal–Wallis test, with a significance threshold set at p < 0.05. Results: Analysis demonstrated a weak but statistically significant positive correlation between age and SIR, as well as between thoracic kyphosis (Cobb angle) and SIR. Patients in Group C (Cobb angle ≥ 47°) showed higher mean SIR values (43.7°) compared to Group A (40.3°), with statistical significance achieved (p = 0.047). These findings suggest that greater thoracic kyphosis is associated with increased scapular internal rotation. No significant correlation was identified between anterior scapular tilt and thoracic kyphosis. Conclusions: This study reveals a correlation between increased thoracic kyphosis and greater scapular internal rotation in patients undergoing RSA. These postural and biomechanical alterations may have critical implications for surgical planning and postoperative outcomes. Preoperative assessment of sagittal spinal alignment, particularly thoracic kyphosis, should be integrated into the planning process for RSA to optimize implant positioning and improve functional results. Full article

Background: Glenohumeral instability is one of the most frequent and clinically impactful complications following proximal humerus resection and reconstruction with a megaprosthesis, especially in patients treated for bone tumors or complex fractures. Its incidence, risk factors, and influence on functional recovery remain variably reported in the literature. Methods: A systematic review was conducted according to PRISMA guidelines, searching PubMed, Scopus, and Google Scholar up to April 2025. Studies reporting on postoperative instability, dislocation, functional outcomes (MSTS, DASH), and related complications were included. Two independent reviewers performed data extraction and quality assessment. A pooled analysis was performed using random-effects models. Results: A total of 17 studies including 387 patients were analyzed. The pooled incidence of glenohumeral instability was 32%, with a revision surgery rate of 10% due to instability. The most common reconstruction technique was modular megaprosthesis (47%), followed by allograft–prosthesis composites (APCs) and reverse total shoulder arthroplasty (RSA). Functional outcomes were reported in 12 studies using the Musculoskeletal Tumor Society (MSTS) score, with a weighted mean of 22.3 ± 3.8 (74.3% ± 12.7%). Disabilities of the Arm, Shoulder, and Hand (DASH) scores, reported in 3 studies, showed worse outcomes in unstable shoulders (mean 61.4 ± 5.2 vs. 26.6 ± 4.1). Soft tissue reconstruction, particularly involving the rotator cuff and deltoid, significantly influenced postoperative stability and function. Conclusions: Glenohumeral instability after proximal humerus megaprosthesis is a common and disabling complication that adversely affects functional outcomes and revision rates. Optimizing soft tissue management and prosthetic design is essential to improve joint stability and long-term results. Full article

Background/Objectives: In reverse shoulder arthroplasty (RSA), precise K-wire positioning of the glenoid component is critical to prevent complications such as glenoid loosening or instability as well as premature implant failure. Optimal component placement must adhere to individualized preoperative plans to account for patient-specific anatomical conditions. Conventional methods often fail to achieve this level of accuracy, undermining the need for personalized medicine. Intraoperative navigation systems are growing in use to improve accuracy in orthopedic surgery. This study aimed to compare the accuracy of K-wire positioning in a 3D-printed model of the scapula using conventional versus navigated methods. Methods: We recruited 20 participants: 10 experienced surgeons and 10 inexperienced medical students. Each participant performed four K-wire drillings—two with conventional instruments and two with an intraoperative navigation system. A novel target system, BoneTrack3D, was used to measure accuracy. We assessed the absolute deviation of the entry and exit points as well as the three-dimensional drilling angle. Results: The navigated method was significantly more accurate for all measured parameters at a family-wise significance level of α = 0.05. The median absolute deviation for the entry point was 1.6 mm with navigation versus 3.0 mm with the conventional method (p < 0.001). Similarly, the exit point deviation was 1.8 mm with navigation versus 6.7 mm conventionally (p < 0.001). The drilling angle deviation also showed significant improvement with navigation, at 2.6° compared to 8.9° conventionally (p < 0.001). However, the navigated method took longer, with a median drilling time of 100.0 s compared to 55.0 s for the conventional method (p < 0.001). The navigated method provided consistent and superior results regardless of a participant’s surgical experience. Conclusions: Navigated techniques for K-wire positioning in RSA demonstrate enhanced accuracy in a 3D-printed model, effectively executing a precise, patient-specific preoperative plan. This could be a direct contribution to personalized medicine, ensuring the final implant alignment is tailored to the individual’s anatomy. Furthermore, intraoperative navigation may contribute to a flatter learning curve, thereby increasing accessibility for surgeons with varying levels of experience. Although navigation introduces additional costs and longer initial procedure times, these drawbacks could be offset by improved technical outcomes and a reduced risk of complications. Future studies, including randomized clinical trials and cost-effectiveness analyses, should seek to validate these results in clinical settings with longer follow-up periods and larger patient cohorts to define long-term value and utility of navigation systems in reverse shoulder arthroplasty. Full article

Background/Objectives: Reverse shoulder arthroplasty (RSA) using a 135-degree inlay-type humeral stem has recently gained popularity due to its bone-preserving design. However, stem subsidence (hereafter, subsidence) and its contributing factors are poorly understood. We aimed to investigate the incidence of subsidence and its associated factors in patients undergoing RSA using a 135-degree inlay-type stem. Methods: A total of 44 shoulders treated with uncemented Tornier Perform^® Reversed Stems were retrospectively analyzed. Radiographic evaluations included stem alignment and canal filling ratio at three levels. The outcome, subsidence, was defined as >5 mm inferior migration of the stem. Results: Subsidence was observed in 6 shoulders (13.6%), which showed significantly greater stem alignment and lower proximal filling ratio. Logistic regression analysis identified proximal filling ratio <80% as an independent risk factor (odds ratio: 70.0, 95% confidence interval: 3.6–1342.6). Conclusions: Although the findings remain exploratory due to the small sample size and short follow-up period, they suggest that inadequate proximal fit may contribute to subsidence in 135-degree inlay RSA. Ensuring proper stem sizing and alignment during implantation may be essential to improving initial stability and clinical outcomes. Larger, long-term studies are required to generalize these conclusions. Full article

This scoping review assessed the current use of wearable sensors in monitoring recovery following reverse shoulder arthroplasty (RSA). A systematic search of electronic databases was undertaken (MEDLINE, EMBASE, CINAHL, and Web of Science) between 2005 and 2024 following the PRISMA-ScR protocol. Studies were eligible if they were peer reviewed, available in full text, and reported the use of wearable sensors to evaluate shoulder motion or activity in postoperative RSA patients. Fifty-seven studies were identified, of which six met the inclusion criteria. Studies were either focused on assessing shoulder motion (n = 3) or on measuring upper limb activity counts or activity intensities (n = 3); however the calculation of output variables were different across most studies. Sensors were positioned on the operated upper arm in all studies, though sensor placement on the sternum and the wrist varied. Session durations ranged from 24 h to continuous monitoring beyond seven days. Daily wear times were most commonly during full waking hours. The large variation in wearable sensor configuration, testing protocols, and the calculation of output variables limited the comparability across studies. Standardization in sensor protocols and outcomes is required to enable the reliable wearable assessment of postoperative recovery after RSA. Full article

Background: Severe glenoid bone loss presents a major challenge in both primary and revision reverse shoulder arthroplasty (RSA). Standard implants often fail to achieve reliable fixation in these cases. Custom-made, 3D-printed glenoid components have emerged as a potential solution, offering anatomically tailored fit and fixation. This study evaluates the clinical and radiographic outcomes of custom-made glenoid implants in managing severe glenoid bone loss. Methods: A retrospective, multicenter study was conducted on 23 shoulders (11 primary and 12 revision RSAs) that received a custom-made glenoid component using the Enovis ProMade System (San Daniele del Friuli, Udine, Italy) between 2017 and 2022, with a minimum follow-up of 24 months. Preoperative planning utilized CT-based 3D modeling to design implants with patient-specific instrumentation. Clinical outcomes (ROM, pain, Constant–Murley score) and radiographic results were assessed. Statistical comparisons were made between primary and revision groups. Results: Both groups demonstrated significant improvements in shoulder mobility, pain relief, and Constant–Murley scores (all p < 0.001), with no significant differences between primary and revision groups in delta scores. Radiographically, no loosening was observed, with minimal radiolucent lines and low complication rates. Four cases of instability occurred, all in the revision group, with only one requiring conversion to hemiarthroplasty. No differences in radiographic outcomes were observed between groups. Conclusions: Custom-made glenoid implants provide a reliable solution for severe glenoid bone loss in both primary and revision RSA, yielding consistent functional improvement and implant stability. Further prospective studies with larger cohorts and long-term follow-up are warranted to confirm these findings and assess cost-effectiveness. Full article

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article

Background/Objectives: Reverse shoulder arthroplasty (RSA) has been widely used for the treatment of shoulder pathologies, particularly rotator cuff tear arthropathy. Currently, it is also increasingly performed for different indications. Like in any arthroplasty procedure, periprosthetic joint infection (PJI) is one of the most concerning complications and may have devastating outcomes. This study aimed to identify risk factors for PJI following RSA. Methods: This retrospective case-control study was conducted with patients who underwent RSA during the study period. Based on PJI occurrence during the follow-up period, patients were divided into two groups: Group I (no infection) and Group II (infection). The relationship between numerous clinical variables and PJI was tested. All variables were initially evaluated through univariate analysis between the two groups, and variables showing significant differences between the two study groups were subjected to multivariate logistic regression analysis to determine independent risk factors. Results: The study included 302 patients, with a mean age of 69.6 ± 10.1 years and a mean follow-up duration of 59.8 ± 24.7 months. During the follow-up period, PJI was not detected in 289 patients (95.7%) (Group I), while 13 patients (4.3%) developed PJI (Group II). Univariate analysis revealed a significant association between preoperative C-reactive protein (CRP) value (p = 0.001) and preoperative diabetes history (p = 0.007) with PJI. Multivariate logistic regression analysis, including these two variables, showed that diabetes was an independent risk factor for PJI development (p = 0.01, odds ratio = 4.85). Preoperative CRP elevation was not observed as an independent risk factor. Conclusions: This study demonstrated a significant association between high preoperative CRP levels and diabetes with PJI. Additionally, the presence of diabetes was identified as an independent risk factor for infection, with a 4.85-fold higher risk of PJI development in patients with a history of diabetes. Full article

Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional computed tomography (3D CT) scans have proven to be efficient tools for improving the accuracy and stability of the glenoid component. However, this technology is still developing, and there is currently little available research on the subject, especially where clinical outcomes are concerned. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients that underwent RSA with the use of these new technologies, compared to a standard procedure. Materials and Methods: A consecutive series of 80 patients underwent RSA for shoulder osteoarthritis by a single surgeon at a single institution with a mean follow-up of 41.9 ± 23.6 months (range 24–108) and were divided into two groups according to the surgical technique employed (conventional or navigated surgery), and they were clinically and radiographically assessed at 1, 3, 6, and 12 months after surgery, and then annually. Results: No statistically significant differences were highlighted among the two groups according to complication rate, radiographical glenoid notching, and clinical outcomes. However, a statistically significant difference was observed in screw number and length and surgical time. In the navigated group, fewer screws with longer lengths had been implanted, with a longer surgical time. Conclusions: The use of 3D CT-based preoperative planning and intraoperative navigation is a safe procedure and produces comparable results with respect to standard instrumentation, without an increased risk of complications. It allowed to achieve higher stability of the implant, saving bone stock due to the use of fewer and longer screws than in a conventional procedure. This could also eventually result in a higher longevity of the implant itself. Full article

Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty. Full article