RESUMEN
BACKGROUND: Fixation of the baseplate to the glenoid for the Reverse Shoulder Prosthesis (DJO Surgical, Austin, TX, USA) requires secure screw purchase to avoid excessive micromotion and baseplate failure. The best screw length for fixation is unknown. In addition, excessively long screws or a plunge of the drill bit during baseplate insertion could injure surrounding structures. METHODS: Reverse Shoulder Prosthesis baseplates were inserted in 10 fresh-frozen shoulders by use of a 6.5-mm central screw and four 5.0-mm peripheral locking screws placed 90° to the baseplate. The top superior screw was placed into the base of the coracoid, corresponding to the 1-o'clock position in a right shoulder. The distances to surrounding vital structures were recorded, screws were removed, and screw hole lengths were measured to determine the most effective lengths in different parts of the glenoid scapula. RESULTS: The screw length was 30 mm for the superior screw holes, 28 mm for the inferior screw holes, 13 mm for the anterior screw holes, and 15 mm for the posterior screw holes. The central screw trajectory was through the anterior cortex. The anterior screw trajectory violated the subscapularis belly in all specimens. The posterior screw touched the suprascapular nerve or artery in 3 of 10 specimens. DISCUSSION: The superior and inferior screws have the longest bony fixation. Drill bit plunge during placement of the anterior screw poses a risk to the subscapularis muscle. Drilling for the posterior screw risks injury to the suprascapular nerve and artery at the spinoglenoid notch. CONCLUSIONS: The posterior screw should be placed with care to avoid neurovascular complications.
Asunto(s)
Artroplastia de Reemplazo/métodos , Tornillos Óseos , Articulación del Hombro/cirugía , Disección , Humanos , Diseño de PrótesisRESUMEN
BACKGROUND: Reverse total shoulder arthroplasty has shown promising early and midterm results; however, complication rates remain a concern. Glenoid loosening and notching, for example, can be deleterious to the long-term success. A 15° inferior inclination angle has been shown to offer the most uniform compressive forces across the base plate and the least micromotion at the base plate-glenoid interface. The inferior inclination angle may also avoid scapular notching. The purpose of this study was to determine the accuracy of obtaining 15° of inferior inclination of the base plate. METHODS: The radiographs of 138 reverse total shoulder patients were included. Overall, glenoid inclination and change in inclination from preoperative radiographs were measured using a previously described standardized method. Measurements were obtained by 2 orthopedic surgeons, who repeated all measurements 3 weeks apart. The final angle and change in inclination were averaged. RESULTS: Seventy-two patients had pre- and postoperative radiographs of sufficient quality to accurately measure inclination. Average pre- and postoperative inclination measured -4.8° (-27.2° to 28.1°) and -13.3° (-22.8° to 43.6°), respectively. The average change in inclination was -8.5° (-53.7(o) to 34.6(o)). No scapular notching was observed, which may relate to the lateralized center of rotation of the implant used in this study. DISCUSSION: Overall, the average decrease in inclination was very close to the intended target value using the standard guide. However, patients with preoperative superior glenoid erosion from advanced rotator cuff tear arthropathy appeared to be consistently tilted superiorly, suggesting the standard guide may be inadequate in these patients.