Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.

Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years Ek, Eugene T H; Neukom, Lisa; Catanzaro, Sabrina; Gerber, Christian Abstract: BACKGROUND: The role of reverse shoulder arthroplasty (RTSA) in the relatively young individual is currently unclear. Our study evaluates the midterm to long-term results of RTSA for patients aged younger than 65 years with pseudoparalysis secondary to massive irreparable rotator cuff tears, with or without arthritis. METHODS: Between 1997 and 2006, 46 RTSAs (41 patients) were performed. Mean age was 60 years (range, 46-64 years). At the latest follow-up, 5 patients had died and 1 was lost, leaving 35 patients (40 shoulders) with a mean follow-up of 93 months (range, 60-171 months). RESULTS: The mean relative Constant score increased from 34% to 74% (P < .0001) and the subjective shoulder value improved from 23% to 66% (P < .0001). Significant improvements were seen in active forward elevation (72°to 119°), pain scores, and strength (P < .001). One or more complications occurred in 15 shoulders (37.5%), with 6 failures (15%) resulting in removal or conversion to hemiarthroplasty (3 with infection, 3 with glenoid loosening). Ten shoulders (25%) underwent partial or total component exchange, conversion to hemiarthroplasty, or removal. Of the 15 patients who developed complications, 9 did not require prosthesis removal or conversion and functional outcome and subjective shoulder value were similar to those with no complications (P > .4). CONCLUSION: RTSA in younger patients provides significant subjective improvement and substantial gain in overall function, which is maintained up to 10 years. Although the complication rate is high, most can be treated successfully without compromise to clinical outcome. However, it is imperative that the high complication rate is explained to patients, with the risks and benefits carefully considered. Conflict of interest/Disclaimer: Christian Gerber receives royalties from Zimmer Inc, which is related to the subject of this article. All other authors, their immediate family, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.Reverse shoulder arthroplasty in younger patients 2 ABSTRACT Background:The role of reverse shoulder arthroplasty (RTSA) in the relatively young individual is currently unclear. Our study evaluates the mid to long-term results of RTSA for patients less than 65 years with pseudoparalysis secondary to massive irreparable rotator cuff tears with or without arthritis. Methods:Between 1997 and 2006, 46 RTSAs (41 patients) were performed. Mean age was 60 years (range, 46-64). At latest follow-up, 5 patients had died and 1 was lost, leaving 35 patients (40 shoulders) with a mean follow-up of 93 months (range, 60-171). Results:Mean relative Constant score increased from 34% to 74% (p<0.0001) and subjective s...

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Coracoid transfer as described by Latarjet can effectively restore anterior glenohumeral shoulder stability if previous operation(s) have failed to do so. If recurrence is associated with chronic pain, the pain is likely to persist and compromise the subjective outcome.

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Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Due to the aging population with poor bone quality the frequency of complex proximal humerus fractures increases. An operative reconstruction and internal fixation is very challenging and is not always possible. Secondary impaction, screw perforations and humeral head necrosis is a common complication. The use of a Reverse Total Shoulder Arthroplasty in the elderly after trauma is a promising alternative. The present multicenter study retrospectively analyzes our long-term experience of reverse total shoulder arthroplasty as a primary treatment in this patient population regarding pain, range of shoulder motion, subjective shoulder value, the constant score, scapular notiching and signs of loosening. Background: Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Methods: Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). Results: There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. Conclusion:The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Level of evidence: Level IV; Case Series; Treatment Study

No abstract