Glenosphere Tilt and Size Predict Shoulder Kinematics During the Hand-to-Back Motion After Reverse Shoulder Arthroplasty.

Abstract

Internal rotation (IR) is not reliably improved after reverse shoulder arthroplasty (RSA). This study aimed to identify surgical parameters that predict kinematics of the hand-to-back motion (H2B) after RSA and to identify associations between kinematics and clinical outcomes after RSA. We hypothesized that less humeral retroversion, more lateralization and a larger glenosphere would predict kinematics associated with favorable outcomes post-RSA. Thirty-five patients performed H2B while synchronized biplane radiographs were collected. Digitally reconstructed radiographs, constructed from patient-specific bone plus implant models, were matched to the biplane radiographs to determine kinematics. The total contribution to motion, the end position, peak angles, and range of motion (ROM) were found for all glenohumeral and scapular rotations. The path of the center of the humeral insert on the glenosphere was calculated. Patient-reported outcomes, clinical ROM, and strength were measured. Associations were determined between intraoperative variables and kinematics as well as between kinematics and outcomes. The results demonstrated that glenosphere tilt predicted glenohumeral and scapular kinematics; these kinematics were associated with IR ROM, strength, and more favorable patient-reported outcomes. A larger glenosphere predicted a center of contact that was associated with more strength in IR. All components of scapular rotation were associated with favorable outcomes, suggesting rehabilitation focusing on scapular motion may improve outcomes post-RSA. Glenosphere tilt and size predicted kinematics that were associated with range of motion, strength, and patient-reported outcomes.