Humeral component version has no effect on outcomes following reverse total shoulder arthroplasty

1. Neutral version and 30° retroversion humeral components in reverse total shoulder arthroplasty had no significant difference in range of motion, muscle strength, or patient-reported outcomes. 

Evidence Rating Level: 1 (Excellent) 

Reverse total shoulder arthroplasty (rTSA) for patients with rotator cuff tear arthropathy improves forward elevation, pain, and function but can result in limited internal and external rotation. The goal of this randomized control trial was to determine if internal and external rotation are affected by the positioning of the humeral component (neutral or 30° of retroversion). Patients were stratified in a 1:1 ratio using a computer-generated randomized sequence and surgeons were informed of decisions just before surgery by non-data collecting personnel. Baseline data was collected before surgery and follow-up data was collected 3 months, 1 year, and 2 years postoperatively. Patients were given a patient-reported outcomes questionnaire and underwent a physical exam by a coordinator blinded to the study groups. Shoulder range of motion was measured using a goniometer, strength was measured using an isometer, and radiographs were obtained at each visit. Both neutral version and retroversion saw significant improvements in forward (97.3° to 139.1°and 94.0° to 132.2° respectively, p<0.001 in both groups). Similarly, active abduction improved significantly in both neutral version and retroversion groups (94.9° to 134.9°, p<0.002; and 86.2° to 128.6°, p<0.001 respectively). Neither group saw a significant increase in active internal or external rotation. Patient-reported outcomes also showed significant improvement overall but no differences between groups. Finally, both groups showed significant improvement in strength in forward elevation, abduction, and external rotation. Only the retroversion group showed a significant improvement in internal rotation strength. Overall, no significant differences were noted between the two groups.

Click to read the study in the Journal of Bone and Joint Surgery

Image: PD

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