Can we separately measure Glenoid versus Humeral Lateralization and Distalization in Reverse Shoulder Arthroplasty?

BACKGROUND

Lateralization and distalization in reverse shoulder arthroplasty (RSA) can be measured on anteroposterior (AP) radiographs using two previously described angles: LSA ("Lateralization Shoulder Angle") and DSA ("Distalization Shoulder Angle"). However, these two angles measure global lateralization and distalization but do not allow to differentiate how much lateralization or distalization are attributable to the glenoid and the humerus. We hypothesized that new angles could allow to separately measure glenoid versus humeral lateralization and distalization. A more precise understanding of independent glenoid and humeral contributions to lateralization and distalization may be beneficial in subsequent clinical research.

METHOD

Retrospective analysis of postoperative AP radiographs of 100 patients who underwent primary RSA for cuff-tear arthropathy (CTA), massive cuff-tear (MCT), or glenohumeral osteoarthritis (GHOA) were analyzed. The new angles that we proposed use well-known bony landmarks (the acromion, glenoid, and humerus) and the most lateral point of the glenosphere which we termed "glenoid pivot point" (GPP). For lateralization, we used the GPP to split LSA into two new angles: Glenoid Lateralization Angle (GLA) and Humeral Lateralization Angle (HLA). For distalization, we introduced the modified Distalization Shoulder Angle (mDSA) that can also be split into two new angles: Glenoid Distalization Angle (GDA) and Humeral Distalization Angle (HDA). Three orthopedic surgeons measured the new angles, using the online tool Tyche. Mean values with overall and individual standard deviations, as well as Intra-Class Correlations (ICCs) were calculated.

RESULTS

Since the angles form a triangle, the following equations can be made: LSA = GLA + HLA. mDSA = GDA + HDA. All angles showed excellent inter- and intraobserver reliability (ICC = 0.92 - 0.97) with low means of individual standard deviations that indicate a precision of 2° for each angle.

CONCLUSION

Use of the most lateral part of the glenosphere (termed "glenoid pivot point") allows to separately measure glenoid versus humeral lateralization and distalization. The four new angles (HLA, GLA, GDA, HDA) described in the present study, can be used on true AP radiographs, routinely obtained after shoulder replacement and the measured angles may be used with all types of reversed prostheses available.

Informations de copyright

Copyright © 2023. Published by Elsevier Inc.