The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty

J Shoulder Elbow Surg. 2019 Jul;28(7):1281-1290. doi: 10.1016/j.jse.2018.11.074. Epub 2019 Mar 29.


Background: Avoiding superior inclination of the glenoid component in reverse shoulder arthroplasty (RSA) is crucial. We hypothesized that superior inclination was underestimated in RSA. Our purpose was to describe and assess a new measurement of inclination for the inferior portion of the glenoid (where the baseplate rests).

Methods: The study included 47 shoulders with rotator cuff tear arthropathy (mean age, 76 years). The reverse shoulder arthroplasty angle (RSA angle), defined as the angle between the inferior part of the glenoid fossa and the perpendicular to the floor of the supraspinatus, was compared with the global glenoid inclination (β angle or total shoulder arthroplasty [TSA] angle). Measurements were made on plain anteroposterior radiographs and reformatted 2-dimensional (2D) computed tomography (CT) scans by 3 independent observers and compared with 3-dimensional (3D) software (Glenosys) measurements.

Results: The mean RSA angle was 25° ± 8° on plain radiographs, 20° ± 6° on reformatted 2D CT scans, and 21° ± 5° via 3D reconstruction software. The mean TSA angle was on average 10° ± 5° lower than the mean RSA angle (P < .001); this difference was observed regardless of the method of measurement (radiographs, 2D CT, or 3D CT) and type of glenoid erosion according to Favard. In Favard type E1 glenoids with central concentric erosion, the difference between the 2 angles was 12° ± 4° (P < .001).

Conclusion: The same angle cannot be used to measure glenoid inclination in anatomic and reverse prostheses. The TSA (or β) angle underestimates the superior orientation of the reverse baseplate in RSA. The RSA angle (20° ± 5°) needs to be corrected to achieve neutral inclination of the baseplate (RSA angle = 0°). Surgeons should be aware that E1 glenoids (with central erosion) are at risk for baseplate superior tilt if the RSA angle is not corrected.

Keywords: BIO-RSA; Glenoid inclination; RSA angle; augmented baseplate; reverse shoulder arthroplasty; superior tilt; β angle.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Shoulder / methods*
  • Female
  • Glenoid Cavity / diagnostic imaging*
  • Glenoid Cavity / pathology
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Middle Aged
  • Shoulder Joint / diagnostic imaging*
  • Shoulder Joint / surgery
  • Tomography, X-Ray Computed