Conversion of Failed Reverse Total Shoulder Arthroplasty to Hemiarthroplasty: Three Cases of Instability and Three Cases of Glenoid Loosening

Abstract

BackgroundGlenoid loosening and postoperative instability are common causes of failed reverse total shoulder arthroplasty (RTSA). When soft-tissue problems or large glenoid bone defect interferes with reimplantation in revision RTSA, conversion to hemiarthroplasty can be considered. We present a case series of patients who underwent conversion to hemiarthroplasty due to glenoid loosening and early instability after RTSAs, along with clinical results.MethodsA total of 72 primary RTSAs using the Aequalis prosthesis were performed at our institution from May 2009 to December 2016. Of these, five patients, including one with humeral neck fracture and absent rotator cuff and four with cuff tear arthropathy, underwent conversion to hemiarthroplasty. Another patient who had RTSA at a local clinic underwent hemiarthroplasty at our institution for unresolved postoperative anterior dislocation. The mean age of the six patients was 71.7 years (range, 62 to 76 years), and the mean follow-up period was 24.4 months (range, 18 to 30 months). Clinical assessments were conducted by using the visual analog scale (VAS), American Shoulder and Elbow Surgery (ASES) score, and University of California at Los Angeles (UCLA) shoulder score at the last follow-up.ResultsThe conversion to hemiarthroplasty in the six patients dramatically improved the mean VAS score (preoperative, 8.1; postoperative, 2.5), ASES score (preoperative, 22.1; postoperative, 56.5), and UCLA score (preoperative, 12; postoperative, 18.1). However, the range of motion was almost unchanged after surgery.ConclusionsConversion to hemiarthroplasty can be a good alternative to revision RTSA in patients with serious complications (such as unresolved instability and glenoid loosening) difficult to treat with revision RTSA.

Glenohumeral joint auto-fusion in a morbidly obese patient intubated for severe COVID-19 infection

“…While patients report improved pain scores, range of motion is typically unchanged. 10 , 19 In this patient’s case, the HA allows him limited but painless range of motion and increased stability of his glenohumeral joint.…”

Instability of a reverse total shoulder arthroplasty treated with a novel allograft capsule reconstruction: a case report

“…Options for remediation at that point are limited and include conversion to hemiarthroplasty or resection arthroplasty, both of which are associated with restricted function. 3 , 7 Recently Tashjian et al described a technique for revision RTSA for instability where cerclage suture is used to secure the humeral component to the glenosphere. 8 Our technique is similar in that it is an attempt to provide an additional level of constraint to prevent the dissociation of the humeral and glenoid component.…”

“…In these cases, patients are routinely treated with conversion to hemiarthroplasty or explant of the prosthesis which results in reliable pain control, but decreased function of the arm. 3 , 7 We describe here our procedure for soft tissue reconstruction of an unstable RTSA which had radiographically appropriate implant position and arm length but continued to have dislocations. To the best of our knowledge, this is the first case report of a soft tissue reconstruction for an unstable RTSA.…”

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

“…For example, Cho CH [31] believed that we should pay great attention to the complications of acromion fractures that commonly occur after surgery. Since RSA is limited by glenoid loosening and instability, prosthesis implantation failure may occur, Song IS et al [32] believed that hemiarthroplasty could better solve such problems, and postoperative follow-up score and joint range of motion were satisfactory.…”