Early restoration of shoulder function in patients with the Grammont prosthesis compared to lateralized humeral design in reverse shoulder arthroplasty

Abstract

Background: This study aimed to compare the clinical outcomes and radiographic parameters of patients after reverse shoulder arthroplasty (RSA) between the Grammont prosthesis and lateralized humeral design prosthesis. Methods: A total of 114 patients who underwent RSA with a lateralized humeral design (group L; 71 shoulders) and medialized humeral design (group M; 43 shoulders) prosthesis for cuff tear arthropathy or irreparable rotator cuff tear were enrolled. Clinical outcomes including visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Constant scores and range of motion (ROM) were serially followed up at postoperative 3, 6, 12, and 24 months. Radiographic parameters were measured to evaluate preoperative and postoperative status. Results: Both prostheses demonstrated similar clinical outcomes and shoulder function preoperatively and at postoperative 2 years (P >.05). However, patients in group M had significantly better postoperative active forward flexion (postoperative 3 months, 115 degrees +/- 12 degrees vs. 101 degrees +/- 14 degrees; P <.001; 6 months, 125 degrees +/- 13 degrees vs. 118 degrees +/- 13 degrees; P <.013) and abduction (3 months, 105 degrees +/- 12 degrees vs. 98 degrees +/- 12 degrees; P = .002); VAS (3 months, 3.1 +/- 1.2 vs. 3.7 +/- 1.4; P = .031; 6 months, 2.3 +/- 1.1 vs. 2.8 +/- 1.3; P = .038); ASES (3 months, 64.2 +/- 7.0 vs. 60.4 +/- 9.2; P = .022; 6 months, 70.6 +/- 6.0 vs. 66.6 +/- 8.1; P = .007); and Constant scores (6 months, 59.6 +/- 6.9 vs. 55.7 +/- 9.3; P = .020). Group L showed a significantly lower rate of scapular notching than group M (15.5% vs. 41.8%; P < .001). The position of the proximal humerus in group L was more lateralized and less distalized than in group M after RSA. Conclusions: RSA with both the Grammont and lateralized humeral design prostheses provided similar shoulder ROM restoration and functional improvements at a minimum of 2 years. However, patients with a humeral lateralized prosthesis showed slower recovery of shoulder function and ROM up to postoperative 6 months despite a lower incidence of scapular notching. (C) 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.