ArticleJSES international2026
Relationship between implant positioning and post-operative scapulohumeral rhythm following reverse total shoulder arthroplasty.
Article in JSES international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Scapulohumeral rhythm (SHR) after reverse total shoulder arthroplasty (rTSA) is typically reduced, with shoulder elevation relying predominantly on scapulothoracic motion. Previous studies have shown that higher post-operative SHR is associated with improved shoulder elevation and superior patient-reported outcome measures. Therefore, despite the non-anatomic design of rTSA, achieving a favorable SHR is desirable. Although implant positioning is believed to influence post-operative shoulder kinematics, the specific implant-related factors contributing to improved SHR remain unclear. This study aimed to investigate the relationship between post-operative SHR and changes in humeral lateralization or distalization, as well as medialization or distalization of the center of rotation. Methods: Forty-six shoulders from 45 patients who underwent rTSA at a single institution and achieved more than 90° of humeral abduction were included. The cohort comprised 27 men and 18 women with a mean age of 75 years. Three implant configurations were used as follows: medialized glenoid-medialized humerus, medialized glenoid-lateralized humerus, and medialized glenoid-mildly lateralized humerus. At a mean of 14 months post-operatively, computed tomography and fluoroscopy were performed during active scapular plane abduction. Three-dimensional implant and scapular motions were analyzed using model-image registration. SHR was calculated from 20° to 90° of humeral abduction. Implant positioning parameters were measured from post-operative radiographs, and changes from pre-operative values were calculated. Correlations between SHR and each parameter were assessed using Pearson correlation coefficient. Results: The mean SHR was 1.39 ± 0.64. A significant positive correlation was identified between post-operative SHR and the change in humeral distalization (r = 0.321, Conclusion: The increase in humeral distalization from the pre-operative to the post-operative state following rTSA showed a significant but weak positive correlation with post-operative SHR, whereas no other implant positioning parameters were significantly correlated with post-operative SHR.
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