Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system

Castagna, Alessandro; Delcogliano, Marco; de, Francesca; Ziveri, Giovanni; Borroni, Mario; Gumina, Stefano; Postacchini, Franco; Biase, Carlo Felice De

doi:10.1007/s00264-013-1907-4

Cited by 78 publications

(45 citation statements)

References 43 publications

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“…This is consistent with the literature, in which the most common reasons for failure of hemiarthroplasties or total shoulder arthroplasties include superior migration or subluxation of the humeral head secondary to rotator cuff dysfunction occurring in 17% to 54% of patients [2,7,13,17,19,30,34] with the likelihood of a higher incidence with longer followup [5,34]. Our study showed that a modular stem designed for exchange has distinct advantages in the case of revision and that the quality of implantation (prosthetic height and torsion) at the index operation is important, because improper positioning can mandate stem exchange even in a system designed to allow stem preservation.…”

Section: Discussionsupporting

confidence: 92%

Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Wieser

Borbas

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background If revision of a failed anatomic hemiarthroplasty or total shoulder arthroplasty is uncertain to preserve or restore satisfactory rotator cuff function, conversion to a reverse total shoulder arthroplasty has become the preferred treatment, at least for elderly patients. However, revision of a well-fixed humeral stem has the potential risk of loss of humeral bone stock, nerve injury, periprosthetic fracture, and malunion or nonunion of a humeral osteotomy with later humeral component loosening. Questions/purposes The purposes of this study were to determine whether preservation of a modular stem is associated with (1) less blood loss and operative time; (2) fewer perioperative and postoperative complications, including reoperations and revisions; and/or (3) improved Constant and Murley scores and subjective shoulder values for conversion to a reverse total shoulder arthroplasty compared with stem revision. Methods Between 2005 and 2011, 48 hemiarthroplasties and eight total shoulder arthroplasties (total = 56 shoulders; 54 patients) were converted to an Anatomical TM reverse total shoulder arthroplasty system without (n = 13) or with (n = 43) stem exchange. Complications and revisions for all patients were tallied through review of medical and surgical records. The outcomes scores included the Constant and Murley score and the subjective shoulder value. Complete clinical followup was available on 80% of shoulders (43 patients; 45 of 56 procedures, 32 with and 13 without stem exchange) at a minimum of 12 months (mean, 37 months; range, 12-83 months). Results Blood loss averaged 485 mL (range, 300-700 mL; SD, 151 mL) and surgical time averaged 118 minutes (range, 90-160 minutes; SD, 21 minutes) without stem exchange and 831 mL (range, 350-2000 mL; SD, 400 mL) and 176 minutes (range, 120-300 minutes; SD, 42 minutes) with stem exchange (p = 0.001). Intraoperative complications (8% versus 30%; odds ratio [OR], 5.2) and reinterventions (8% versus 14%; OR, 1.9) were substantially fewer in patients without stem exchange. The complication rate leading to dropout from the study was substantial in the stem revision group (six patients; 43 shoulders [14%]), but there were no complication-related dropouts in the stemretaining group. If, however, such complications could be avoided, with the numbers available we detected no difference in the functional outcome between the two groups. Conclusions Patients undergoing revision of stemmed hemiarthroplasty or total to reverse total shoulder arthroplasty without stem exchange had less intraoperative blood loss and operative time, fewer intraoperative complications, and fewer revisions than did patients whose index revision procedures included a full stem exchange.

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Section: Discussionsupporting

confidence: 92%

Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Wieser

Borbas

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…A recent study reported a 0 % rate of humeral tuberosity or shaft fractures in patients with platform humeral stems converted to RTSA [13]. A similar study of 26 patients with full modular stems likewise reported no intraoperative humeral complications [18].…”

Section: Uses and Advantages Of A Platform Systemmentioning

confidence: 92%

“…Castagna, et al recently published a series of 26 patients who underwent conversion of a previous shoulder arthroplasty to an RTSA using a platform system [18]. The index operation in 18 of the patients was hemiarthroplasty for fracture; the remaining 8 patients had an ATSA for glenohumeral arthritis.…”

Section: Clinical Outcomes Using Platform Systemsmentioning

confidence: 99%

“…At an average of 32 months follow-up, the average constant score improved from 25 points to 48 points, while the EuroQol Visual Analog Scale (EQ-VAS) improved from 40 preoperatively to 70 postoperatively. All patients improved in terms of range of motion and follow-up imaging obtained at final follow-up demonstrated good integration of the implants without any evidence of loosening [18]. A recent study published by Wieser, et al evaluated outcomes in 48 patients with hemiarthroplasties and eight patients with ATSA converted to RTSA with (n = 43) and without (n = 13) stem exchange to elucidate potential advantages of a platform system [17•].…”

Section: Clinical Outcomes Using Platform Systemsmentioning

confidence: 99%

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Platform systems in shoulder arthroplasty

Werner

Dines

2016

Curr Rev Musculoskelet Med

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A platform system for shoulder arthroplasty can include a convertible modular humeral stem and/or a metal-backed glenoid component to facilitate straightforward conversion from either a hemiarthroplasty or anatomic total shoulder arthroplasty to a subsequent anatomic total shoulder arthroplasty, or more frequently, reverse total shoulder arthroplasty without any revision to the stem and/or glenoid baseplate. Recent studies have demonstrated a decreased rate of intraoperative humeral fracture, complications, and blood loss when a platform system is used and the humeral stem is not exchanged during revision arthroplasty. Future studies with larger patient cohorts are necessary to truly evaluate the potential value and limitations of this technology.

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“…Some authors chose metallic lateralisation of the COR, which keeps the humeral bearing away from the pillar of the scapula. Several implants were designed according to this concept: the RSP (DJO Surgical, Austin, TX, USA) [16], the SMR (Lima, Udine, Italy) [5][6][7] and the Arrow RSA (FH Orthopedics, Mulhouse, France) [28,42]. In the latter, the design of the glenosphere and metal baseplate allows COR lateralisation of 8.5 mm.…”

Section: Introductionmentioning

confidence: 99%

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

Katz¹,

Valenti²,

Kany³

et al. 2015

International Orthopaedics (SICOT)

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Purpose Our purpose was to evaluate the influence of metallic lateralisation of the centre of rotation (COR) in reverse shoulder arthroplasty (RSA) on the incidence of scapular notching and its eventual clinical and radiological consequences. Methods We analysed 140 RSAs with a lateralised design (Arrow, FH Orthopedics, Mulhouse, France) implanted for massive rotator cuff tear with/without arthritis. Mean followup was 45 months (range 24-120, standard deviation 20). Patients were evaluated clinically using the Constant and Murley (Clin Orthop Relat Res 214:160-164, 1987) score and active range of motion (ROM) and radiologically using standard anteroposterior and axillary view. Scapular notching was assessed according to Sirveaux classification Simovitch et al. (J Bone Joint Surg Am, 89:588-600, 2007), and patients were separated into two groups (scapular notch/no scapular notch) and compared. Results Forty-one notches (29 %) were found: 20 grade 1, 18 grade 2, and three grade 3. The latter three patients had a follow-up of 44, 70 and 84 months, respectively, and the scapular notch did not evolve in the final two years. Better preoperative function was significantly associated with scapular notching (p<0,05 for flexion and abduction), but no final clinical differences in ROM and Constant score were found between groups. A body mass index (BMI) <30 increased the risk of scapular notching, which was observed in 43 % of patients with a BMI<30 and 30 % of patients with a BMI> 30 p=0,048). Pre-operative narrowing of the subacromial space increased the risk of scapular notching, but age or gender showed no influence. However, there was a significantly greater number of scapular notches in patients operated on the dominant side (p=0,04). No significant difference in lateral offset was found between groups (p=0,99). Glenoid implantation in an excessively high position (p=0,033) and absence of inferior tilt (p=0,0029) were significantly associated with scapular notching. Conclusions In this series, metallic lateralisation of the COR in RSA did not impair clinical results, with patients achieving good flexion recovery ROM increase in rotations. Metallic lateralisation of the COR in RSA leads to a lower incidence of scapular notching (29 %) compared with previously reported results using other arthroplastic systems with a more medialised COR. However, although scapular notching was not totally eliminated, those that were found did not evolve over time. Several factors increased the incidence of scapular notching: BMI <30, better preoperative ROM, an excessively high glenoid implant and absence of inferior tilt.

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Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system

Cited by 78 publications

References 43 publications

Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Platform systems in shoulder arthroplasty

Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow-up

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