Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study

Abstract

Purpose The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. Methods This was a prospective comparative nonrandomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. Results We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome.Conclusions Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.

Short to mid-term results of stemless reverse shoulder arthroplasty in a selected patient population compared to a matched control group with stem

“…In our series one patient (132°humeral component) presented with a post-traumatic dislocation which was successfully treated with a higher liner and subscapularis reinsertion. This instability rate (4 %) is comparable with rates of previous reports for stemless RSA (0 %, 1 %, 2 %, and 13 %) [13][14][15][16], as well as the traditional Grammont design (4 %) [22].…”

“…No general loosening of the humeral component was noted in both groups, which confirms previous findings [13][14][15][16]. While in the RSA group with stem 29 % of the cases showed radiolucencies or visible bone density loss in one or two of eight zones, in none of the cases more than two zones were affected.…”

“…The lack of a stem allows free placement of the humeral component in all planes which on the one hand creates a great opportunity for the surgeon to freely choose a combination of retroversion, offset, and inclination, but on the other hand represents a challenge to the surgeons technical skills to obtain the desired positioning. Accordingly, the most common complication reported in previous studys of the same stemless RSA implant was early humeral component break-out (0 %, 2 %, 2 %, and 13 %) not only attributed to poor bone quality but also implantation mistakes [13][14][15][16]. In our series with strict selection criteria (selection rate <20 %) no early or late humeral component break-out occurred.…”

“…Accordingly only a few outcome reports on stemless RSA can be found in the literature. While the published short to mid-term clinical and radiological outcomes seem to be promising all published case series lack an outcome assessment by an independent observer [13][14][15][16], except for one report regarding RSA with mini-stem [17].…”

Complications of Shoulder Arthroplasty

“…Raiss et al demonstrated a reduction in survivorship at 10 and 15 years after TSA performed with cement secondary to pain and implant loosening; revision procedures occurred at a mean of 8.8 years from the date of implantation 125 . The five RSA studies with minimum follow-up of 5 years noted scapular notching and instability as the most common complications 28 [33][34][35][36][37][38][39][44][45][46][47][48]50,51,53,54,[56][57][58][59]61,64,65,67,69,70,73,75,79,81,[88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]104,105,…”