Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure—midterm results

Flury, Manuel; Frey, Philipp; Goldhahn, Jörg; Schwyzer, Hans‐Kaspar; Simmen, Beat R.

doi:10.1007/s00264-010-0990-z

Cited by 135 publications

(94 citation statements)

References 29 publications

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“…With instability, secondary cuff failures, or glenoid erosion, the humeral component often is well fixed in the humeral shaft. Revision of a 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 [8,12,32]. Newer modular stemmed shoulder arthroplasty systems theoretically allow conversion to reverse total shoulder arthroplasty without stem exchange.…”

Section: Introductionmentioning

confidence: 99%

“…If a prosthesis fails, however, because of loosening, infection, instability, glenoid wear, or rotator cuff dysfunction, serious challenges can arise [1,4,11,16,22,24,28,31]. If revision is uncertain to preserve or restore clinically satisfactory cuff function, conversion to reverse total shoulder arthroplasty has become the preferred treatment, especially for elderly patients [8,20,23,33].…”

Section: Introductionmentioning

confidence: 99%

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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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Besides CTA, the indications for RSA include comminuted shoulder fractures, revisions, rheumatoid arthritis (RA) and severe osteoarthritis (OA) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

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

Kadum

Mukka

Englund

et al. 2014

International Orthopaedics (SICOT)

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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.

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“…La bibliografía que hace referencia a este tema es escasa. De acuerdo con Flury y cols., 9 el 43% de los casos (9/21) tuvo complicaciones intraoperatorias, y la fractura humeral fue la más frecuente. El 38% (8/21) sufrió complicaciones posoperatorias, entre ellas, neuropatía del nervio radial, trombosis de la vena humeral, neumotórax, infección, hematomas, disestesias y aflojamiento de la glenoesfera.…”

Section: Discussionunclassified

Ruptura irreparable del Manguito Rotador en Artroplastía de Hombro: Resolución “simple” de la complicación con Artroplastía Reversa

Pereira¹,

Wittwer²,

Rellán³

et al. 2017

Rev Asoc Arg Ortop Traumatol (Supl)

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Rev Asoc Argent Ortop Traumatol (Supl.) 2017; 82: 2-7. S2 ResumenLa lesión del manguito rotador en pacientes con una prótesis total de hombro anatómica es cada vez más frecuente. Ante esta situación surge el dilema de reparar la ruptura o efectuar una revisión hacia una artroplastia inversa. Se presenta el caso de un paciente que consulta por una ruptura masiva del manguito rotador del hombro derecho, de seis meses de evolución, luego de haber intentado levantar un objeto de 30 kg. Como antecedente se le había implantado una artroplastia total del hombro derecho modular y universal por artrosis glenohumeral primaria. Dada la irreparabilidad de la lesión y la adecuada integración biológica proximal del tallo humeral cementado y el platillo metálico glenoideo no cementado, se procedió a la reconversión a artroplastia inversa de hombro intercambiando solo los componentes modulares de la próte-sis. La evolución posquirúrgica fue favorable, recuperó un rango de movilidad satisfactorio durante la rehabilitación. Las prótesis modulares universales ofrecen la posibilidad de la conversión "simple" de una artroplastia de hombro total a una inversa, sin necesidad de revisar el tallo humeral ni el platillo glenoideo, y así disminuir la morbilidad del procedimiento.Palabras clave: Hombro; artroplastia; manguito rotador; artroplastia inversa. Nivel de Evidencia: IVRotator cuff tear after anatomic shoulder arthroplasty: "Simple" revision to reverse arthroplasty AbstractRotator cuff injury in patients with anatomical total shoulder prosthesis is becoming more frequent. These cases present with the dilemma of whether to repair the rupture or make a revision towards a reverse arthroplasty. We present the case of a patient who suffered a massive rotator cuff rupture of the right shoulder, after lifting a 30-kg object, 6 months ago. Because of glenohumeral osteoarthritis, the patient underwent a modular total shoulder arthroplasty 16 months before. Given the irreparable lesion, the adequate proximal biological integration of the cemented humeral stem, and the uncemented glenoid metallic plate, a conversion to reverse shoulder arthroplasty was performed by exchanging only the modular components of the prosthesis. Postoperative evolution was favorable; the patient regained a satisfactory range of motion during rehabilitation. Universal modular prostheses offer the possibility of "simple" conversion to a reverse arthroplasty, without exchanging the humeral stem or the glenoid plate, and thus reducing the morbidity of the procedure.

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Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure—midterm results

Cited by 135 publications

References 29 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

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

Ruptura irreparable del Manguito Rotador en Artroplastía de Hombro: Resolución “simple” de la complicación con Artroplastía Reversa

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