Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Purpose Revision surgery for shoulder prosthesis remains a difficult task in shoulder surgery. The purpose of this retrospective study was to evaluate the clinical and radiological outcomes of a series of 30 reverse shoulder prostheses performed as revision of failed hemi- or total shoulder arthroplasty. The most relevant technical points in surgery are described, as are other surgical options; a rational strategy for the treatment of these patients is proposed.Materials and methodsThirty patients (average age 69.5) were included. Mean follow-up was 36.4 months (range 24–100 months). There were 14 patients in group 1 (Delta III) and 16 in group 2 (Reverse Arrow).ResultsA total of 83 % were satisfied (16 cases) or very satisfied (9 cases), and 17 % were disappointed (5 patients). The mean Constant score increased from a mean of 25–52. The mean score for pain improved from 5 (range 0–15) to 13 (range 5–15) (p < 0.001). The mean score of strength improved from 1 (range 0–6) to 5 (range 0–10) (p < 0.001). The forward elevation changed from a mean of 55° (range 0–120) to 108° (range 40–160) (p < 0.001). There was no significant improvement of external rotation at 0° abduction (range 14°–18°) or internal rotation (range 5–4.63). There were 4 scapular notching. We could not find the influence of scapular notching on Constant Score. Complication rate was 26.6 %.ConclusionReverse total shoulder arthroplasty prosthesis represents an available option in difficult cases of failed hemiarthroplasty or total shoulder arthroplasty when the rotator cuff is irreparable and the glenoid bone stock is sufficient.Level of evidenceLevel 4.

The uncemented glenoid implants in total anatomical shoulder arthroplasty are likely to be accused of problems like dissociations, secondary rotator cuff tear, and wear of polyethylene (PE). This work is a clinical and radiological prospective review of 143 cases of anatomical total shoulder arthroplasty using a new metal back uncemented glenoid implant (MB) in order to see if this new implant induces those complications. A total of 143 cases were operated between 2003 and 2011. In a first part, the whole series of 143 cases was radiologically studied in order to quantify the lateralisation induced by the MB implant. In a second study, 37 cases had a mean follow-up of 38 months (24–75, mean 32) and served for the clinical and radiological final study. Pre- and postoperative clinical evaluation was done using the Constant–Murley score and the simple shoulder test from Matsen. The final X-rays served to detect an eventual secondary narrowing of the joint space and to analyse the frequency of radio lucent lines (RLL) and loosenings. Despite a small radiological lateralisation in comparison with the normal contralateral side (0.36 cm, p = 0.02), the clinical results after 2 years were similar to the published cemented glenoid implants series but without any RLL, glenoid loosening or joint narrowing. Some dissociations occured in the beginning and definitely eliminated by a design modification of the PE tray. The discussion tried to show that, despite a still short follow-up, this series is encouraging to continue to use this new MB implant. Different applications of the concept of universality and conversion are discussed, this tray been also the support of a glenosphere in reverse arthroplasty.

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