Kinematic analysis of dynamic shoulder motion in patients with reverse total shoulder arthroplasty

Background: Reverse total shoulder arthroplasty (rTSA) has been used to treat patients with irreparable rotator cuff dysfunction. Despite the proven clinical efficacy, there is minimal information regarding the underlying changes to the shoulder kinematics associated with this construct. Therefore, we sought to examine the kinematics of dynamic shoulder motion in patients with well-functioning rTSA. Methods: We tested 12 healthy subjects and 17 patients with rTSA. All rTSA patients were able to elevate their arms to at least 90 degrees and received the implant as the primary arthroplasty at least 6 months before testing. On average, the rTSA patients elevated their arms to 112 degrees +/- 12 degrees (mean +/- SD) and reported an American Shoulder and Elbow Surgeons outcome score of 90.6 +/- 6.3. A 3-dimensional electromagnetic motion capture device was used to detect the dynamic motion of the trunk, scapula, and humerus during bilateral active shoulder elevation along the sagittal, scapular, and coronal planes. Results: In both healthy and rTSA shoulders, the majority of the humeral-thoracic motion was provided by the glenohumeral motion. Therefore, the ratio of glenohumeral to scapulothoracic (ST) motion was always greater than 1.62 during elevation along the scapular plane. In comparison to healthy subjects, however, the contribution of ST motion to overall shoulder motion was significantly increased in the rTSA shoulders. This increased contribution was noted in all planes of shoulder elevation and was maintained when weights were attached to the arm. Conclusion: Kinematics of the rTSA shoulders are significantly altered, and more ST motion is used to achieve shoulder elevation. Level of evidence: Basic Science Study, Kinesiology Study. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.