Management of Revision Reverse Shoulder Arthroplasty

Goldman, Brian H.; Halpern, Abby L.; Deal, Matthew Jordan; Richey, Bradley; Mason, Eric M.; Gupta, Hari Om; Callegari, Jonathan J.; Bravo, César J.

doi:10.1177/2471549220902296

Cited by 3 publications

(2 citation statements)

References 49 publications

(136 reference statements)

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“…These can generally be compensated for by keeping the implant proud while employing cementation techniques [37]. Bone grafting of the residual tuberosities and fixation to the stem generally result in a suitable outcome.…”

Section: Bone Deficiencies Proximal To the Pectoralis Major Tendon In...mentioning

confidence: 99%

“…Bone Deficiencies below the Pectoralis Major Origin but Proximal to Deltoid Insertion (6-14 cm) These generally cannot be compensated for by keeping the stem proud. Accurate reconstruction of the humeral deficiency, either with an APC or proximal humeral replacement prosthesis, is advised (Figure 7) [37]. Care must be taken to preserve the deltoid insertion at all costs, as this has a significant bearing on the patient's early postoperative active abduction and flexion.…”

Section: Bone Deficiencies Proximal To the Pectoralis Major Tendon In...mentioning

confidence: 99%

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Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Italia

Launay

Gilliland

et al. 2022

JCM

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Revision shoulder arthroplasty is increasing with the number of primary shoulder replacements rising globally. Complex primary and revisions of shoulder arthroplasties pose specific challenges for the surgeon, which must be addressed preoperatively and intraoperatively. This article aimed to present strategies for the management of revision of shoulder arthroplasties through a single-stage approach. Preoperatively, patient factors, such as age, comorbidities, and bone quality, should be considered. The use of planning software can aid in accurately evaluating implants in situ and predict bony anatomy that will remain after explantation during the revision surgery. The planning from such software can then be executed with the help of mixed reality technology to allow accurate implant placement. Single-stage revision is performed in two steps (debridement as first step, implantation and reconstruction as the second step), guided by the following principles: adequate debridement while preserving key soft tissue attachments (i.e., rotator cuff, pectoralis major, latissimus dorsi, deltoid), restoration of glenoid joint line using bone grafting, restoration of humeral length, reconstruction and/or reattachment of soft tissues, and strict compliance with the postoperative antibiotic regimen. Preliminary results of single-stage revision shoulder arthroplasty show improvement in patient outcomes (mean 1 year), successful treatment of infection for those diagnosed with periprosthetic joint infection, and improved cost–benefit parameters for the healthcare system.

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Section: Bone Deficiencies Proximal To the Pectoralis Major Tendon In...mentioning

confidence: 99%

Section: Bone Deficiencies Proximal To the Pectoralis Major Tendon In...mentioning

confidence: 99%

Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Italia

Launay

Gilliland

et al. 2022

JCM

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Yoke procedure as a salvage treatment option for failed reverse total shoulder arthroplasty with irreconstructible glenoid

Nezwek

Dutcher

et al. 2024

Journal of Shoulder and Elbow Surgery

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Outcomes of revision versus re-revision reverse total shoulder arthroplasty: A case–control-matched cohort study

S O'Keefe,

Teurlings,

Hao

et al. 2023

Shoulder & Elbow

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Background The increasing incidence of reverse total shoulder arthroplasties (RTSA) has led to an increase in revision surgery. We aimed to compare patients undergoing re-revision RTSA to a matched cohort undergoing first-revision RTSA. Methods A retrospective review of all revision RTSAs was performed at a single institution. Sixteen shoulders that underwent re-revision RTSA were matched 1:3 to shoulders that underwent revision RTSA with a minimum two-year follow-up. Outcome scores including the American Shoulder and Elbow Surgeons Shoulder Score (ASES), Short-Form 12 (SF-12), Shoulder Pain and Disability Index (SPADI), and Simple Shoulder Test (SST) scores, range of motion (ROM), and improvement from preoperative to postoperative outcomes after re-revision RTSA were assessed. Additionally, postoperative outcomes after re-revision RTSA were compared to patients that underwent first revision RTSA and subsequently compared to the minimal clinically important difference (MCID) values for the outcome scores and ROM measurements assessed. Results Sixteen shoulders that underwent re-revision RTSA and 78 revision RTSAs met the final inclusion criteria to be included in this study. Significant improvement from preoperative to postoperative re-revision RTSA was seen in the ASES score (p = 0.046), SPADI score (p = 0.044), SST (p = 0.008), abduction (p = 0.016), and elevation (p = 0.025), but not the SF-12 score (p = 0.396), external rotation (p = 0.449), or internal rotation (p = 0.451). Outcomes after revision RTSA were found to be superior to outcomes after re-revision RTSA for all outcome scores (ASES p = 0.029, SF-12 p = 0.018, SPADI p = 0.003) except the SST score (p = 0.080) and all ROM measures (p > 0.05 for all). Internal rotation was equivalent postoperatively between both groups. From preoperative to postoperative re-revision RTSA, the mean improvement exceeded the MCID for the SST score, abduction, forward elevation, and external rotation. When comparing postoperative revision RTSA to postoperative re-revision RTSA, the mean difference between revision and re-revision RTSA exceeded the MCID for the SPADI score and external rotation. The complication rate was 19% in shoulders undergoing first revision and 41% in shoulders undergoing re-revision RTSA. Conclusion Patients undergoing re-revision RTSA receive improvement in clinical outcomes, but do not achieve outcomes comparable to those achieved after first revision RTSA.

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Management of Revision Reverse Shoulder Arthroplasty

Cited by 3 publications

References 49 publications

Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution

Yoke procedure as a salvage treatment option for failed reverse total shoulder arthroplasty with irreconstructible glenoid

Outcomes of revision versus re-revision reverse total shoulder arthroplasty: A case–control-matched cohort study

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