A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty

Middernacht, Bart; Tongel, Alexander Van; Wilde, Lieven De

doi:10.1155/2016/3256931

Cited by 34 publications

(13 citation statements)

References 68 publications

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“…In fact, Moroder and colleagues [78] compared the clinical and radiological outcomes of stemless RTSA with a matched cohort of patients undergoing conventional uncemented stemmed RTSA for rotator cuff arthropathy and found no differences between groups. Considering the indication when selecting the stem length is crucial, as a stemless prosthesis may be appropriate in patients with primary cuff tear arthropathy, while a proximal humerus fracture will necessitate the use of a stemmed prosthesis [80]. Moreover, a stemless prosthesis can result in substantial variability in the neck-shaft angle.…”

Section: Stem Lengthmentioning

confidence: 99%

“…The stability of the RTSA is dependent on the contact area between the glenosphere and polyethylene inlay, which can range from minimal (high mobility) to maximal (constrained or retentive) [5,80,81]. Retentive liners can afford additional implant stability; however, they do so with the risk of increased wear and possible polyethylene wear-induced aseptic loosening [82,83].…”

Section: Polyethylene Insertmentioning

confidence: 99%

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Reverse Total Shoulder Arthroplasty: Implant Design Considerations

Sheth

Saltzman

2019

Curr Rev Musculoskelet Med

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Purpose of Review Our understanding of the reverse total shoulder arthroplasty (RTSA) has grown exponentially since Grammont first introduced his design in 1985. There are a multitude of implant-related variables to consider when performing RTSA. The purpose of this article is to provide a review of these design considerations. Recent Findings Current literature demonstrates that the traditional Grammont prosthesis has over 90% survivorship at 10 years. Despite these promising results, there have been concerns raised over the significant rate of scapular notching observed. As a result, the traditional RTSA design has been modified to minimize this complication and maximize impingement-free motion. Modern RTSA designs with a cementless, curved, short-stemmed eccentric onlay humeral component combined with a large, lateralized glenosphere placed in 10°of inferior tilt with > 3.5 mm of inferior overhang have been found to provide excellent results. However, all implant design features must be considered on a case-by-case basis to optimize outcome for each patient. Summary Humeral and glenoid implant design variables have evolved as the biomechanics of RTSA have been further elucidated. Consideration of these variables allows the surgeon to maximize joint efficiency, improve impingement-free range of motion, decrease the risk of scapular notching, preserve bone stock, and minimize the risk of instability.

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Section: Stem Lengthmentioning

confidence: 99%

Section: Polyethylene Insertmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty: Implant Design Considerations

Sheth

Saltzman

2019

Curr Rev Musculoskelet Med

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“…Reverse shoulder arthroplasty (RSA) is a well-established procedure to treat rotator cuff tear arthropathy by replacing the arthritic joint and moving the center of rotation of the shoulder inferiorly and medially thereby engaging the functional capacity of the deltoid to elevate the arm in the absence of a functional rotator cuff. 1 For this indication, 10-year implant survivorship is 89%, with 90% patient satisfaction at a mean of 4.3 years. [2][3][4] However, RSA complication rates range from 13-25% after primary arthroplasty surgeries and 37-69% of revisions.…”

Section: Introductionmentioning

confidence: 98%

Case Report: Watching and Waiting? A Case of Incomplete Glenosphere Seating With Spontaneous Reversal in Reverse Shoulder Arthroplasty

MacAskill

Thomas

Barnes

2020

Journal of Shoulder and Elbow Arthroplasty

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Introduction: Reverse shoulder arthroplasty is a useful procedure with broadening applications, but it has the best outcomes when used for rotator cuff tear arthropathy. However, this procedure is not without complications. While scapular notching and aseptic loosening are more common complications that have been extensively studied in the literature, dissociation of the glenoid component and incomplete glenosphere seating has not received much attention. Specifically, little research has explored appropriate management of incomplete seating of the glenosphere component, and no gold standard for treatment of this complication has emerged. Methods: In the case described here, an elderly patient with an incompletely seated glenosphere component post-operatively opted to pursue conservative management in order to avoid revision surgery if possible. Results: The partially engaged, superiorly directed components in this case exhibited spontaneous complete and symmetric seating of the glenosphere between six and twelve months post-operatively, indicating that conservative management of this complication in low-demand patients may be a viable option to avoid the risks associated with revision surgery. Conclusion: Further research should be pursued to explore what patient and prosthesis design factors may be suited to observation with serial radiographs when incomplete seating of the glenosphere component occurs.

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“…Prior reports of increased rates of complications in RTSA compared with TSA may not accurately reflect current complication rates for reasons such as the rapidly evolving RTSA surgical technique and implant design. The Grammont prosthesis underwent a complete evolution and now has an increased head-neck offset of 135° in certain manufacturers vs. the original 155° system that was developed in 1987 24 . Patients undergoing RTSA also reportedly experience significantly longer hospital admissions and increased hospital costs independent of higher RTSA implant costs compared with TSA and HA patients 16…”

mentioning

confidence: 99%

Reverse shoulder arthroplasty has higher perioperative implant complications and transfusion rates than total shoulder arthroplasty

et al. 2019

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Background Indications for reverse total shoulder arthroplasty (RTSA) have expanded. The purpose of this retrospective cohort study was to evaluate national trends in shoulder arthroplasty utilization and to compare national perioperative complication rates for hemiarthroplasty (HA), total shoulder arthroplasty (TSA), and RTSA in a matched cohort. Methods The National Inpatient Sample was queried from 2011-2013 to identify patients who underwent HA, TSA, or RTSA. Age, sex, race, insurance type, Elixhauser comorbidity index, and perioperative complications were identified. A coarsened exact matching algorithm was used to match RTSA patients with TSA and HA patients to compare medical and implant-related perioperative in-hospital complications. Multivariable logistic regression analysis was performed on unmatched data to identify risk factors for development of perioperative complications. Results Overall, 42,832 shoulder arthroplasties were identified (44% TSAs, 34% RTSAs, 19% HAs). After matching, RTSAs had 6.2 times the odds of a perioperative implant-related complication ( P < .001) and 2 times the odds of a red blood cell transfusion compared with TSAs ( P < .001). The logistic regression model showed that prior shoulder arthroplasty (odds ratio [OR], 15.1; P < .001), younger age (OR, 0.98; P = .006), earlier year of index surgery (OR, 0.83; P = .002), history of illicit drug use (OR, 6.2; P = .008), and depression (OR, 2.3; P = .003) were risk factors for development of in-hospital implant-related complications after RTSA. Conclusion The perioperative implant-related complication rate and postoperative transfusion rate of RTSAs were significantly higher than those of TSAs. In addition, prior shoulder surgery, younger age, earlier year of index surgery, history of illicit drug use, and depression were risk factors for implant-related complications after RTSA. However, the perioperative RTSA implant-related complications did decline each year, suggesting a growing national proficiency with performing RTSA.

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A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty

Cited by 34 publications

References 68 publications

Reverse Total Shoulder Arthroplasty: Implant Design Considerations

Reverse Total Shoulder Arthroplasty: Implant Design Considerations

Case Report: Watching and Waiting? A Case of Incomplete Glenosphere Seating With Spontaneous Reversal in Reverse Shoulder Arthroplasty

Reverse shoulder arthroplasty has higher perioperative implant complications and transfusion rates than total shoulder arthroplasty

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