RESUMEN
Hypothesis: The reverse shoulder arthroplasty, as introduced by Grammont, has had many modifications over time. One of these modifications was reducing the neck-shaft angle (NSA) from 155 degrees to 135 degrees. Biomechanical studies indicated that lowering the NSA increases external rotation and reduces abduction and the incidence of scapular notching. The purpose of this study was to compare range of motion, functional outcome measures, and complications in patients undergoing reverse shoulder arthroplasty, depending on the NSA, through a systematic review and meta-analysis. Methods: A literature search was conducted (articles published from January 1985 to January 2020) in the PubMed/MEDLINE, Embase, and CINAHL databases and the Cochrane library. All studies reporting outcomes after primary reverse shoulder arthroplasty for osteoarthritis and rotator cuff-related disease were included. Patients were divided into 2 groups: a medialized design (MD) with an NSA of 150-155 degrees and a lateralized design (LD) with an NSA of less than 150 degrees. Pooled effects were calculated in the form of mean differences and 95% confidence intervals (CIs). Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies - of Interventions tool for non-Randomized Controlled Trials and the Risk Of Bias 2 tool for Randomized Controlled Trials. Results: A total of 21 studies and 3134 arthroplasties were included: 1366 with an MD and 1678 with an LD. The mean age was 73.0 years (MD 74.0 and LD 72.5). A direct comparative meta-analysis was not feasible, and therefore, all data were compared using the minimal clinically important difference. The MD group demonstrated a larger improvement in abduction (56.76°, 95% CI 37.03-76.49) than the LD group (48.52°, 95% CI 28.27-68.78), however the LD group demonstrated a larger improvement in external rotation with the arm at the side (MD: 7.69°, 95% CI 0.01-15.37; LD: 16.14° 95% CI 7.18-25.09). When looking at the postoperative range of motion, the MD group had more abduction than the LD group (MD: 136.28°, 95% CI 127.36-145.20; LD: 127.77° 95% CI 117.02-138.52). Both designs had a comparable improvement in the Constant Murley score (MD 42.04 points, LD 41.14 points). Lowering the NSA was accompanied by a decrease in dislocation rate (MD: 4.6%; LD: 1.4%; P value .037) and notching rate (MD: 40.3%; LD: 17.3%; P value <.0001). Conclusion: In our analysis, lowering the NSA decreases the amount of abduction but increases the amount of external rotation. This change in range of motion is accompanied by less scapular notching and dislocations. There is no clear impact on functional outcome measures.
RESUMEN
This retrospective study reports medium term outcomes of 14 total wrist arthroplasties in patients with especially, non-rheumatoid, degenerative osteo- arthritis and post-traumatic osteoarthritis with a mean follow up of 5 to 10 years. Information of fourteen patients, 6 men and 8 women with a mean age of 61 years, was collected before and after total wrist arthroplasty (Universal 2 prosthesis, Integra) carried out by a single surgeon. Pre-operative mobility was determined by range of motion and compared to post- operative range of motion. Post-operative function was determined using the DASH (The disabilities of the arm, shoulder and hand) score and the PRWE (patient-rated wrist evaluation and grip strength) score. Grip force between the operated and non- operated hand were compared postoperatively. Three patients experienced complications. Range of motion improved post-operatively, although not significantly, due to an increase in palmar flexion. The mean DASH score was 20% and the mean total PRWE was 54%. This study shows that total wrist arthroplasty, using the Universal 2 wrist prosthesis, gives reasonable results (survival rate 84%) by decreasing pain while preserving range of motion in patients with degenerative osteoarthritis of the wrist after 5 years. However the 10-year survival rate decreases steeply to an unsatisfying 35%.