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J Shoulder Elbow Surg. 2019 May;28(5):813-818. doi: 10.1016/j.jse.2018.11.064. Epub 2019 Feb 15.

Can a functional difference be detected in reverse arthroplasty with 135° versus 155° prosthesis for the treatment of rotator cuff arthropathy: a prospective randomized study.

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The Cleveland Shoulder Institute, Beachwood, OH, USA. Electronic address:
The Cleveland Shoulder Institute, Beachwood, OH, USA.
The Orthopedic Clinic Association, Phoenix, AZ, USA; Department of Orthopedic Surgery, Banner University Medical Center, Phoenix, AZ, USA.
Southern Oregon Orthopedics, Medford, OR and Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, OR, USA.



The purpose of this randomized controlled trial was to compare humeral inclinations of 135° and 155° in patients undergoing primary reverse shoulder arthroplasty (RSA). Our hypothesis was that forward flexion would be higher in the 155° group but be associated with a higher rate of scapular notching.


A randomized controlled trial was conducted on 100 primary RSAs performed with a humeral inclination of either 135° or 155°. The prostheses were otherwise identical and a neutral glenosphere was used in all cases. Functional outcome, forward flexion, external rotation, and scapular notching were assessed at a minimum of 2 years postoperatively.


There was no difference in range of motion or functional outcome scores between the 2 groups. In the 155° group, forward flexion improved from 76° to 135° (P < .001) and external rotation remained unchanged (29° vs. 30°; P = .835). In the 135° group, postoperative forward flexion improved from 78° to 132° (P < .001) and external rotation was unchanged (28° vs. 29°; P = .814). Scapular notching was observed in 58% of cases with a 155° inclination compared with 21% with a 135° inclination (P = .009).


With a neutral glenosphere there was no difference in postoperative forward flexion or external rotation after an RSA with a humeral inclination of 135° compared with 155°. Scapular notching was reduced with the use of 135° design compared with a 155° design but persists at a rate of 21% at 2-year follow-up in the absence of a lateralized glenosphere.


135°; 155°; Reverse shoulder arthroplasty; forward flexion; humeral inclination; randomized controlled trial; scapular notching

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