The influence of posture and scapulothoracic orientation on the choice of humeral component retrotorsion in reverse total shoulder arthroplasty

Background: The literature suggests implantation of the humeral component in reverse total shoulder arthroplasty (RTSA) in 0°-40° of retrotorsion without further specification. We hypothesized that optimal humeral component retrotorsion to avoid notching and gain balanced rotational capacity would depend on scapular position and posture.

Methods: We investigated 200 shoulders in 100 patients with available whole-body computed tomography scans and created 3-dimensional models. Implantation of a humeral component in 20° of retrotorsion was simulated, and a correction angle (CA) to yield perfect opposition to the glenosphere was calculated. Patient-specific variables such as age, sex, posture, and scapular orientation parameters were correlated with this CA.

Results: Scapular orientation showed large interindividual differences. A highly significant correlation was seen between the CA and scapular internal rotation (R = 0.71, P < .001) and protraction (R = 0.39, P < .001). When the CA was adjusted for glenoid retroversion, the correlation coefficient of scapular internal rotation increased even further (R = 0.91, P < .001). Scapular internal rotation itself showed a correlation with thoracic kyphosis (R = 0.27, P < .001), protraction (R = 0.57, P < .001), tilt (R = 0.29, P < .001), and scapular translation (R = -0.23, P < .001).

Conclusion: Scapular orientation and posture should be integrated into the determination process of humeral component retrotorsion in RTSA. In theory, implantation of the humeral component with increased retrotorsion leads to improved neutral opposition of the RTSA components in patients with extensive internal rotation of the scapula. On the basis of varying scapular internal rotation, we propose the distinction of 3 different posture types (A-C) for enhanced appraisal of scapulothoracic orientation.