Three-dimensional kinematic evaluation of scapulohumeral rhythm after reverse shoulder arthroplasty: a systematic review and meta-analysis

BACKGROUND: The movement of the arm relative to the trunk results from 3-dimensional (3D) coordinated movements of the glenohumeral (GH) and scapulothoracic (ST) joints and dictates the scapulohumeral rhythm (SHR). Alterations in SHR increase joint overload and may lead to low functional scores, pain, and failures in patients undergoing reverse total shoulder arthroplasty (RSA). The goal of this systematic review and meta-analysis was to examine 3D SHR kinematics after RSA and compare it to that of asymptomatic shoulders. METHODS: A systematic review and meta-analysis of articles in English were performed using PubMed, Embase, Cochrane Library, and SciELO. Additional studies were identified by searching bibliographies. Search terms included “Reverse shoulder arthroplasty”, “3D”, and “scapula”. It was selected cross-sectional studies that reported SHR with 3D motion analysis systems in patients who underwent RSA and asymptomatic controls. Two authors independently performed the extraction of articles using predefined data fields, including study quality indicators. RESULTS: Data from four studies were included in quantitative analysis, totaling 48 shoulders with RSA and 63 asymptomatic shoulders. Pooled analyses were based on random-effects model (DerSimonian-Laird). A statistically smaller SHR ratio was observed in the RSA group than that in the control group (P < .00001), meaning a greater contribution of ST joint in relation to GH joint for arm elevation. The standardized mean difference was −1.16 (95% confidence interval: −1.64, −0.67). A sensitivity analysis with three more studies that had imputed data on control group did not change the direction of the effect. The standardized mean difference on sensitivity analysis was −0.60 (P = .03; 95% confidence interval: −1.13, −0.06). It was detected as “not important heterogeneity” within the comparison (I(2): 22%). Chi-square was not statistically significant (Chi(2): 3.85), and I(2) was 22%. Tau(2) was not zero (Tau(2): 0.05). Sensitivity analysis showed an I(2) of 74%, which might represent substantial heterogeneity, Chi-square was not statistically significant (Chi(2): 23.01), and Tau(2) was not zero (Tau(2): 0.37). CONCLUSION: This study found that RSA shoulders have an increased contribution of ST joint during arm elevation, compared with asymptomatic shoulders. More movement in ST joint in proportion to GH joint increases GH joint contact forces, which could lead to component loosening or other complications. Further studies should address the clinical implications of this kinematic finding.