Onlay Versus Inlay Humeral Component in Reverse Total Shoulder Arthroplasty

Onlay Versus Inlay Humeral Component in Reverse Total Shoulder Arthroplasty: A Prospective, Randomized Trial

The goal of this study is to compare the effect of different ways to place the component that goes at the top of the humerus (upper arm) in reverse total shoulder replacement. Some surgeons place the humeral tray component sitting on the bone while others place it in the bone. Changing the way that the humeral component is placed may change how much the arm can raise up or turn out/in after surgery for some patients. This study compares patients with inlay humeral component (tray sits in the upper arm bone) versus onlay humeral component (tray sits on top of the upper arm bone) to see if there are differences in range of motion or function after surgery.

Study Overview

• Status: Terminated
• Conditions: Rotator Cuff Injuries; Arthritis Shoulder
• Intervention / Treatment: Device: Tornier Ascend Flex stem; Device: Tornier Perform Stem Reverse+

Detailed Description

This study aims to determine if active external rotation two years postoperatively varies based on whether an inlay or onlay humeral component is used in reverse shoulder arthroplasty (RTSA). The study also aims to determine whether active forward elevation, abduction, scapular notching, and functional outcomes two years postoperatively vary based on whether an inlay or onlay humeral component is used in reverse shoulder arthroplasty. Patients undergoing primary RTSA by Dr. J. Michael Wiater, Dr. Brett Wiater, or Dr. Alexander Martusiewicz at Beaumont Health will be screened for eligibility. Following informed consent, participants will be randomised (1:1) to one of the following groups: 1) RTSA with inlay humeral component (Tornier Perform Stem Reverse+) or 2) RTSA with onlay humeral component (Tornier Ascend Flex stem). At baseline, participants will complete study questionnaires, receive a range-of-motion (ROM) exam, and standard of care x-rays and computed tomography (CT) scans. These evaluations will be repeated at 3 months, 12 months and 24 months.

• Study Type: Interventional
• Enrollment (Actual): 19
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Royal Oak, Michigan, United States, 48073
      • William Beaumont Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients undergoing primary reverse total shoulder arthroplasty with the following components:

  1. Onlay group: Ascend Flex stem, Perform Reversed standard +3 lateralized 25mm baseplate with standard 36 mm glenosphere or +6 lateralized 25mm baseplate with 39mm glenosphere
  2. Inlay group: Perform Stem Reverse, Perform Reversed +3 lateralized 25mm baseplate with standard 36mm glenosphere or +6 lateralized 25mm baseplate with 39mm glenosphere
• Diagnosis of cuff tear arthropathy, massive cuff tear, or primary osteoarthritis with cuff tear
• Negative external rotation lag sign, ability to externally rotate beyond neutral
• Age 18 years or older

Exclusion Criteria:

• Revision arthroplasty
• Prior open shoulder surgery
• Concomitant tendon transfer (Latissimus Dorsi, Pectoralis Tendon, Lower Trapezius)
• Diagnosis of rheumatoid arthritis, infection, acute trauma or instability
• Patients not willing to undergo a standardized physical therapy protocol or home therapy program after surgical intervention
• Patient anatomy does not accommodate the study implants per surgeon discretion
• Pregnant, patient-reported
• Minors (under 18 years of age)
• Cognitively impaired based on a diagnosis of dementia, psychiatric disorder, or any cognitive deficit that will not allow for proper informed consent or answering of study questionnaires

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Onlay Component-Tornier Ascend Flex stem; Reverse Total Shoulder Arthroplasty using onlay component (tray placed at top of humerus)	Device: Tornier Ascend Flex stem; Reverse Total Shoulder Arthroplasty using onlay component (tray placed at top of humerus)
Active Comparator: Inlay Component-Tornier Perform Stem Reverse+; Reverse Total Shoulder Arthroplasty using inlay component (tray placed in humerus)	Device: Tornier Perform Stem Reverse+; Reverse Total Shoulder Arthroplasty using inlay component (tray placed in humerus)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Active external rotation, 2 years	Range of motion of repaired shoulder, active external rotation. Measured with goniometer in degrees.	2 years postoperative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Active external rotation, 3 months	Range of motion of repaired shoulder, active external rotation. Measured with goniometer in degrees.	3 months postoperative
Active external rotation, 1 year	Range of motion of repaired shoulder, active external rotation. Measured with goniometer in degrees.	1 year postoperative
Strength during active external rotation, 3 months	Strength measurement during active external rotation of repaired shoulder. Measured with dynamometer in pounds.	3 months postoperative
Strength during active external rotation, 1 year	Strength measurement during active external rotation of repaired shoulder. Measured with dynamometer in pounds.	1 year postoperative
Strength during active external rotation, 2 years	Strength measurement during active external rotation of repaired shoulder. Measured with dynamometer in pounds	2 years postoperative
Active forward elevation, 3 months	Range of motion of repaired shoulder, active forward elevation. Measured with goniometer in degrees.	3 months postoperative
Active forward elevation, 1 year	Range of motion of repaired shoulder, active forward elevation. Measured with goniometer in degrees.	1 year postoperative
Active forward elevation, 2 years	Range of motion of repaired shoulder, active forward elevation. Measured with goniometer in degrees.	2 years postoperative
Strength during active forward elevation, 3 months	Strength measured during active forward elevation of repaired shoulder. Measured with dynamometer in pounds.	3 months postoperative
Strength during active forward elevation, 1 year	Strength measured during active forward elevation of repaired shoulder. Measured with dynamometer in pounds.	1 year postoperative
Strength during active forward elevation, 2 years	Strength measured during active forward elevation of repaired shoulder. Measured with dynamometer in pounds.	2 years postoperative
Abduction, 3 months	Range of motion of repaired shoulder, abduction. Measured with goniometer in degrees.	3 months postoperative
Abduction, 1 year	Range of motion of repaired shoulder, abduction. Measured with goniometer in degrees.	1 year postoperative
Abduction, 2 years	Range of motion of repaired shoulder, abduction. Measured with goniometer in degrees.	2 years postoperative
Strength during abduction, 3 months	Strength measured during abduction of repaired shoulder. Measured with dynamometer in pounds.	3 months postoperative
Strength during abduction, 1 year	Strength measured during abduction of repaired shoulder. Measured with dynamometer in pounds.	1 year postoperative
Strength during abduction, 2 years	Strength measured during abduction of repaired shoulder. Measured with dynamometer in pounds.	2 years postoperative
Internal rotation, 3 months	Range of motion of repaired shoulder, internal rotation. Measured with goniometer in degrees.	3 months postoperative
Internal rotation, 1 year	Range of motion of repaired shoulder, internal rotation. Measured with goniometer in degrees.	1 year postoperative
Internal rotation, 2 years	Range of motion of repaired shoulder, internal rotation. Measured with goniometer in degrees.	2 years postoperative
Strength during Internal rotation, 3 months	Strength measured during internal rotation of repaired shoulder. Measured with dynamometer in pounds.	3 months postoperative
Strength during Internal rotation, 1 year	Strength measured during internal rotation of repaired shoulder. Measured with dynamometer in pounds.	1 year postoperative
Strength during Internal rotation, 2 years	Strength measured during internal rotation of repaired shoulder. Measured with dynamometer in pounds.	2 years postoperative
External rotation lag sign test, 3 months	Number of patients with positive external rotation lag sign test. The test is performed with the elbow passively flexed and repaired shoulder abducted 90 degrees by the examiner. Next, the examiner passively takes the patient's shoulder into a position of maximal external rotation. The patient is then instructed to hold that position. A positive test is if the patient cannot maintain the position and the shoulder rotates internally. A positive test indicates supraspinatus and infraspinatus tendon weakness.	3 months postoperative
External rotation lag sign test, 1 year	Number of patients with positive external rotation lag sign test. The test is performed with the elbow passively flexed and repaired shoulder abducted 90 degrees by the examiner. Next, the examiner passively takes the patient's shoulder into a position of maximal external rotation. The patient is then instructed to hold that position. A positive test is if the patient cannot maintain the position and the shoulder rotates internally. A positive test indicates supraspinatus and infraspinatus tendon weakness.	1 year postoperative
External rotation lag sign test, 2 years	Number of patients with positive external rotation lag sign test. The test is performed with the elbow passively flexed and repaired shoulder abducted 90 degrees by the examiner. Next, the examiner passively takes the patient's shoulder into a position of maximal external rotation. The patient is then instructed to hold that position. A positive test is if the patient cannot maintain the position and the shoulder rotates internally A positive test indicates supraspinatus and infraspinatus tendon weakness.	2 years postoperative
Drop arm test, 3 months	Number of patients with positive drop arm test of repaired shoulder, performed by passively abducting the patient's shoulder and observing for arm drop as the patient slowly lowers the arm to the waist. A positive test indicates supraspinatus dysfunction.	3 months postoperative
Drop arm test, 1 year	Number of patients with positive drop arm test of repaired shoulder, performed by passively abducting the patient's shoulder and observing for arm drop as the patient slowly lowers the arm to the waist. A positive test indicates supraspinatus dysfunction.	1 year postoperative
Drop arm test, 2 years	Number of patients with positive drop arm test of repaired shoulder, performed by passively abducting the patient's shoulder and observing for arm drop as the patient slowly lowers the arm to the waist. A positive test indicates supraspinatus dysfunction.	2 years postoperative
Lift off test, 3 months	Number of patients with positive lift off test. The test is performed by the patient performing internal rotation of repaired shoulder, by lifting the hand off the back while the examiner places pressure on the hand. The test is considered to be positive if the patient cannot resist, lift the hand off the back or if the patient compensates by extending the elbow and shoulder. A positive test indicates subscapularis weakness.	3 months postoperative
Lift off test, 1 year	Number of patients with positive lift off test. The test is performed by the patient performing internal rotation of repaired shoulder, by lifting the hand off the back while the examiner places pressure on the hand. The test is considered to be positive if the patient cannot resist, lift the hand off the back or if the patient compensates by extending the elbow and shoulder. A positive test indicates subscapularis weakness.	1 year postoperative
Lift off test, 2 years	Number of patients with positive lift off test. The test is performed by the patient performing internal rotation of repaired shoulder, by lifting the hand off the back while the examiner places pressure on the hand. The test is considered to be positive if the patient cannot resist, lift the hand off the back or if the patient compensates by extending the elbow and shoulder. A positive test indicates subscapularis weakness.	2 years postoperative
Belly press test, 3 months	Number of patients with positive belly press test. The patient is asked to press the palm of the hand against the abdomen and bring the elbow forward. The test is positive if the patient is unable to maintain maximal internal rotation of repaired shoulder, demonstrates weakness or the elbow deviates posteriorly. A positive test indicates subscapularis muscle dysfunction.	3 months postoperative
Belly press test, 1 year	Number of patients with positive belly press test. The patient is asked to press the palm of the hand against the abdomen and bring the elbow forward. The test is positive if the patient is unable to maintain maximal internal rotation of repaired shoulder, demonstrates weakness or the elbow deviates posteriorly. A positive test indicates subscapularis muscle dysfunction.	1 year postoperative
Belly press test, 2 years	Number of patients with positive belly press test. The patient is asked to press the palm of the hand against the abdomen and bring the elbow forward. The test is positive if the patient is unable to maintain maximal internal rotation of repaired shoulder, demonstrates weakness or the elbow deviates posteriorly. A positive test indicates subscapularis muscle dysfunction.	2 years postoperative
Functional impairment by American Shoulder and Elbow Surgeons' score (ASES), 3 months	Patients will complete a questionnaire of the repaired shoulder function and pain, with 100 maximum points. A score of 0 indicates no impairment (best outcome), and 100 indicates maximum impairment (worst outcome).	3 months postoperative
Functional impairment by American Shoulder and Elbow Surgeons' score (ASES), 1 year	Patients will complete a questionnaire of the repaired shoulder function and pain, with 100 maximum points. A score of 0 indicates no impairment (best outcome), and 100 indicates maximum impairment (worst outcome).	1 year postoperative
Functional impairment by American Shoulder and Elbow Surgeons' score (ASES), 2 years	Patients will complete a questionnaire of shoulder function and pain, with 100 maximum points. A score of 0 indicates no impairment (best outcome), and 100 indicates maximum impairment (worst outcome).	2 years postoperative
Quality of life by Western Ontario Osteoarthritis of the Shoulder score (WOOS), 3 months	Patients complete a questionnaire comprising 4 domains of: physical symptoms; sports, recreation and work; lifestyle; and emotions. Each question is answered using a visual analog scale with a possible score ranging from 0 to 100. There are 19 questions, and the total score ranges from 0 to 1900. A score of 1900 signifies that the patient has an extreme decrease in the shoulder-related quality of life (worst outcome), whereas a score of 0 signifies that the patient has no decrease in shoulder-related quality of life (best outcome).	3 months postoperative
Quality of life by Western Ontario Osteoarthritis of the Shoulder score (WOOS), 1 year	Patients complete a questionnaire comprising 4 domains of: physical symptoms; sports, recreation and work; lifestyle; and emotions. Each question is answered using a visual analog scale with a possible score ranging from 0 to 100. There are 19 questions, and the total score ranges from 0 to 1900. A score of 1900 signifies that the patient has an extreme decrease in the shoulder-related quality of life (worst outcome), whereas a score of 0 signifies that the patient has no decrease in shoulder-related quality of life (best outcome).	1 year postoperative
Quality of life by Western Ontario Osteoarthritis of the Shoulder score (WOOS), 2 years	Patients complete a questionnaire comprising 4 domains of: physical symptoms; sports, recreation and work; lifestyle; and emotions. Each question is answered using a visual analog scale with a possible score ranging from 0 to 100. There are 19 questions, and the total score ranges from 0 to 1900. A score of 1900 signifies that the patient has an extreme decrease in the shoulder-related quality of life (worst outcome), whereas a score of 0 signifies that the patient has no decrease in shoulder-related quality of life (best outcome).	2 years postoperative
Global Health, by Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) score, 3 months	Patients will complete the PROMIS-10 assessment of global health for the previous 7 days, a 10-question assessment where each statement is scored from 1 (poor health) to 5 (excellent health) on a Likert scale. A total score is summed from the 10 questions, resulting in a minimum of 10 and maximum of 50 points. Higher scores indicate better health (best outcome).	3 months postoperative
Global Health, by Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) score, 1 year	Patients will complete the PROMIS-10 assessment of global health for the previous 7 days, a 10-question assessment where each statement is scored from 1 (poor health) to 5 (excellent health) on a Likert scale. A total score is summed from the 10 questions, resulting in a minimum of 10 and maximum of 50 points. Higher scores indicate better health (best outcome).	1 year postoperative
Global Health, by Patient-Reported Outcomes Measurement Information System Global 10 (PROMIS-10) score, 2 years	Patients will complete the PROMIS-10 assessment of global health for the previous 7 days, a 10-question assessment where each statement is scored from 1 (poor health) to 5 (excellent health) on a Likert scale. A total score is summed from the 10 questions, resulting in a minimum of 10 and maximum of 50 points. Higher scores indicate better health (best outcome).	2 years postoperative
Visual Analog Scale measure of pain, 3 months	Shoulder-related pain reported by the patient for the repaired shoulder as a score on a visual analog scale from 0 to 10, where 0=no pain at all (best outcome), and 10=pain as bad as it can be (worst outcome).	3 months postoperative
Visual Analog Scale measure of pain, 1 year	Shoulder-related pain reported by the patient for the repaired shoulder as a score on a visual analog scale from 0 to 10, where 0=no pain at all (best outcome), and 10=pain as bad as it can be (worst outcome).	1 year postoperative
Visual Analog Scale measure of pain, 2 years	Shoulder-related pain reported by the patient for the repaired shoulder as a score on a visual analog scale from 0 to 10, where 0=no pain at all (best outcome), and 10=pain as bad as it can be (worst outcome).	2 years postoperative
Scapular notching, 3 months	Scapular notching of the repaired shoulder. Measured from radiographic evaluation and scored on the Sirveaux classification scale as Grade 1-4, where grade 1 indicates a defect that only involves the inferior pillar of the scapular neck (best outcome). In Grade 2, the notch contacts the lower screw. In Grade 3, erosion of the bone extends over the lower screw. In Grade 4, the notch extends under the baseplate (worst outcome).	3 months postoperative
Scapular notching, 1 year	Scapular notching of the repaired shoulder. Measured from radiographic evaluation and scored on the Sirveaux classification scale as Grade 1-4, where grade 1 indicates a defect that only involves the inferior pillar of the scapular neck (best outcome). In Grade 2, the notch contacts the lower screw. In Grade 3, erosion of the bone extends over the lower screw. In Grade 4, the notch extends under the baseplate (worst outcome).	1 year postoperative
Scapular notching, 2 years	Scapular notching of the repaired shoulder. Measured from radiographic evaluation and scored on the Sirveaux classification scale as Grade 1-4, where grade 1 indicates a defect that only involves the inferior pillar of the scapular neck (best outcome). In Grade 2, the notch contacts the lower screw. In Grade 3, erosion of the bone extends over the lower screw. In Grade 4, the notch extends under the baseplate (worst outcome).	2 years postoperative
Reoperation	Number of patients requiring reoperation of the same shoulder within 2 years.	2 years postoperative
Study-related adverse events	All adverse events determined by the PI to be probably or definitely related to study interventions (surgery or device).	2 years postoperative

Collaborators and Investigators

• Sponsor: Corewell Health East
• Collaborators: Stryker Nordic
• Investigators: Principal Investigator: Alex Martusiewicz, MD, Beaumont Health

Study record dates

Study Major Dates

• Study Start (Actual): October 20, 2023
• Primary Completion (Actual): November 24, 2025
• Study Completion (Actual): November 24, 2025

Study Registration Dates

• First Submitted: March 16, 2022
• First Submitted That Met QC Criteria: March 16, 2022
• First Posted (Actual): March 28, 2022

Study Record Updates

• Last Update Posted (Estimated): January 16, 2026
• Last Update Submitted That Met QC Criteria: January 15, 2026
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: shoulder pain; shoulder function; shoulder range of motion
• Additional Relevant MeSH Terms: Shoulder Injuries; Pain; Neurologic Manifestations; Musculoskeletal Diseases; Wounds and Injuries; Joint Diseases; Rupture; Tendon Injuries; Arthralgia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Rotator Cuff Injuries; Shoulder Pain
• Other Study ID Numbers: 2022-000

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes