Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties: a systematic review (part I—complications)

Abstract

Background Several modifications to the original Grammont reverse shoulder arthroplasty (RSA) design have been proposed to prevent distinctive issues, such as both glenoid and humeral lateralization. The aim of this systematic review was to determine rates of problems, complications, reoperations, and revisions after onlay lateralized humeral stem RSA, hypothesizing that these are design related. Methods This systematic review was performed in accordance with the PRISMA statement guidelines. A literature search was conducted (01.01.2000–14.04.2020) using PubMed, Cochrane Reviews, Scopus, and Google Scholar employing several combinations of keywords: “reverse shoulder arthroplasty,” “reverse shoulder prosthesis,” “inverse shoulder arthroplasty,” “inverse shoulder prosthesis,” “problems,” “complications,” “results,” “outcomes,” “reoperation,” “revision.” Results Thirty-one studies with 4893 RSA met inclusion criteria. The 892 postoperative problems and 296 postoperative complications represented overall problem and complication rates of 22.7% and 7.5%, respectively. Forty-one reoperations and 63 revisions resulted, with an overall reoperation rate of 1.7% and overall revision rate of 2.6%. Conclusions Problem, complication, and reintervention rates proved acceptable when implanting a high humeral lateralization stem in RSA. The most frequent problem was scapular notching (12.6%), and the most common postoperative complication was scapular stress fracture (1.8%). An overall humeral complication rate of 1.9% was identified, whereas short stems reported no humeral fractures or stem loosening. Infections (1.3%) proved to be the most common reason for component revision, and instability had a complication rate of 0.8%. Level of evidence Systematic review IV

Problems, complications, and reinterventions in 4893 onlay humeral lateralized reverse shoulder arthroplasties, a systematic review: part II—problems and reinterventions

“…The available literature suggests treating displaced transverse fractures through plate osteosynthesis, with or without autologous bone graft [10] and, in the case of associated loosening and/or instability, long stem implant revision is required [61]: 16% and 10% of fractures in this study were treated through osteosynthesis and stem revision, respectively. However, in shoulders with thin cortical bone in the proximal humerus and tuberosities, extensive cementing around the prosthesis in the area of the tuberosities to prevent component rotation may be preferable to revision [22,59,62]. The most common reoperation was open reduction and internal fixation after periprosthetic fracture (0.7%), with 10 reinterventions for a scapular fracture and 8 for a humeral fracture.…”

“…It was hypothesized that emerging reinterventions, problems, and complications are peculiar to new design prostheses and their significance differs from that of Grammont-style RSA. In this part, a systematic review of problems and reinterventions was performed [22].…”

“…CTA cuff tear arthropathy, OA glenohumeral osteoarthritis, FrS fractures sequelae, MRCT massive rotator irreparable cuff tears, Rev revisions, IA inflammatory arthritis, AvN avascular necrosis of the humeral head, AcF acute fractures, InstA instability arthropathy Studies that did not declare number of cases for each etiology Alentorn-Geli 2 , Ascione6 , and Gilot22 did not declare etiologies…”

Onlay versus inlay humeral components in reverse shoulder arthroplasty: A systematic review and meta-analysis

“…Reverse shoulder arthroplasty (RSA) is an effective treatment option for shoulder pathologies such as cuff tear arthropathy, massive rotator cuff tears, proximal humeral fractures, and revisions arthroplasty requirements. 1–8 Numerous technological evolutions in prosthesis designs have allowed for an expansion in indications. 4,9–12 With the many new advancements in RSA, pain and functional outcomes have improved.…”

“…3,10,16,17 However, current discussions over the implant design have included concerns over the possibility of these biomechanical properties leading to increase bony compromise to the scapula. 1,2,9,11,12,17…”