Search

Aims: Optimal glenoid positioning in reverse shoulder arthroplasty (RSA) is crucial to provide impingement-free range of motion (ROM). Lateralization and inclination correction are not yet systematically used. Using planning software, we simulated the most used glenoid implant positions. The primary goal was to determine the configuration that delivers the best theoretical impingement-free ROM. Methods: With the use of a 3D planning software (Blueprint) for RSA, 41 shoulders in 41 consecutive patients (17 males and 24 females; means age 73 years (SD 7)) undergoing RSA were planned. For the same anteroposterior positioning and retroversion of the glenoid implant, four different glenoid baseplate configurations were used on each shoulder to compare ROM: 1) no correction of the RSA angle and no lateralization (C-L-); 2) correction of the RSA angle with medialization by inferior reaming (C+M+); 3) correction of the RSA angle without lateralization by superior compensation (C+L-); and 4) correction of the RSA angle and additional lateralization (C+L+). The same humeral inlay implant and positioning were used on the humeral side for the four different glenoid configurations with a 3 mm symmetric 135° inclined polyethylene liner. Results: The configuration with lateralization and correction of the RSA angle (C+L+) led to better ROM in flexion, extension, adduction, and external rotation (p ≤ 0.001). Only internal rotation was not significantly different between groups (p = 0.388). The configuration where correction of the inclination was done by medialization (C+M+) led to the worst ROM in adduction, extension, abduction, flexion, and external rotation of the shoulder. Conclusion: Our software study shows that, when using a 135° inlay reversed humeral implant, correcting glenoid inclination (RSA angle 0°) and lateralizing the glenoid component by using an angled bony or metallic augment of 8 to 10 mm provides optimal impingement-free ROM. Cite this article: Bone Jt Open 2024;5(10):851–857.

Background: The Trillat procedure is a surgical treatment for recurrent anterior shoulder instability. It consists of an inferior closed-wedge osteoclasy of the coracoid process. Nowadays, it is used to treat selected cases of shoulder instability. This systematic review aims to provide an overview of clinical and functional outcomes, recurrence rate, and complications of the Trillat procedure for recurrent anterior shoulder instability. Methods: A systematic review of the literature regarding the Trillat procedure for recurrent anterior shoulder instability was carried out on Medline, through PubMed, and Embase. The English and French literature published before the 4th of November 2023 was analyzed. The data regarding demographics, outcome, recurrency, and complications were reported. Results: From 38 articles with the primary search, seven manuscripts were enrolled. A total of 419 patients and 443 shoulders were analyzed, with a mean age of 35.46 (range 25-61) years. The mean follow-up was 65.01 (range 24.8-132) months postoperative. The pooled data showed 91.2% of subjective satisfaction, weighted mean postoperative Rowe score of 86.25 points, Walch–Duplay of 84.6 points, and a Constant–Murley Score of 84.82 points. The recurrence rate was 10.28% for all the articles involved and 8.51% for the articles proposing the procedure for selected case of anterior instability, with low-grade glenoid bone loss. The most common complications were a loss of external rotation and the development of osteoarthritis. Conclusion: The Trillat procedure for recurrent anterior shoulder instability showed promising results, especially in selected cases, such as low-grade glenoid bone loss, with massive irreparable cuff tears or hyperlaxity.