Reverse shoulder arthroplasty in revision of failed shoulder arthroplasty—outcome and follow-up

Ortmaier, Reinhold; Resch, Herbert; Matis, Nicholas; Blocher, Martina; Auffarth, Alexander; Mayer, Michaël; Hitzl, Wolfgang; Tauber, Mark

doi:10.1007/s00264-012-1742-z

Cited by 105 publications

(61 citation statements)

References 40 publications

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“…Solutions for stem retention also need to be investigated. In our series, the complication and reoperation rates for patients who have had revision of a hemiarthroplasty or total shoulder to reverse total shoulder arthroplasty without the need for stem exchange compare favorably not only with rates of our control group, but also with reported results [20,21,23,26,33].…”

Section: Discussionsupporting

confidence: 76%

“…Such revisions, however, are associated with the risk of intraoperative and/or postoperative complications [8,12,18,20,21,23,26,27,32,33]. Our study showed that revision of hemiarthroplasties or total-to reverse total shoulder arthroplasties performed without stem removal reduced operative time, blood loss, intraoperative complications, and reoperations compared with stem exchange.…”

Section: Discussionmentioning

confidence: 67%

“…Numerous studies have shown that conversion to reverse total shoulder arthroplasty in patients with prior operations is associated with a substantial risk of intraoperative and postoperative complications and further revision is between 22% and 32% [20,21,23,26,33]. This is markedly higher than the complication rate for primary reverse total shoulder arthroplasty.…”

Section: Discussionmentioning

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: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

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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“…Despite the widespread use of reverse total shoulder arthroplasty (RTSA) [1,11,27], the fundamental effects of implant configuration on certain biomechanical outcomes have not been completely elucidated. The deltoid muscle force required to produce active motion and the resulting joint load magnitude and angle throughout this motion are important factors when considering the potential effect of implant configuration on long-term RTSA performance.…”

Section: Introductionmentioning

confidence: 99%

Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Giles

Langohr

Johnson

et al. 2015

Clinical Orthopaedics &Amp; Related Research

133

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Background Reverse total shoulder arthroplasty (RTSA) is widely used; however, the effects of RTSA geometric parameters on joint and muscle loading, which strongly influence implant survivorship and long-term function, are not well understood. By investigating these parameters, it should be possible to objectively optimize RTSA design and implantation technique. Questions/purposes The purposes of this study were to evaluate the effect of RTSA implant design parameters on (1) the deltoid muscle forces required to produce abduction, and (2) the magnitude of joint load and (3) the loading angle throughout this motion. We also sought to determine how these parameters interacted.Methods Seven cadaveric shoulders were tested using a muscle load-driven in vitro simulator to achieve repeatable motions. The effects of three implant parameters-humeral lateralization (0, 5, 10 mm), polyethylene thickness (3, 6, 9 mm), and glenosphere lateralization (0, 5, 10 mm)-were assessed for the three outcomes: deltoid muscle force required to produce abduction, magnitude of joint load, and joint loading angle throughout abduction. Results Increasing humeral lateralization decreased deltoid forces required for active abduction (0 mm: 68% ± 8% [95% CI, 60%-76% body weight (BW)]; 10 mm: 65% ± 8% [95% CI, 58%-72 % BW]; p = 0.022). Increasing glenosphere lateralization increased deltoid force (0 mm: 61% ± 8% [95% CI, 55%-68% BW]; 10 mm: 70% ± 11% [95% CI, 60%-81% BW]; p = 0.007) and joint loads (0 mm: 53% ± 8% [95% CI, 46%-61% BW]; 10 mm: 70% ± 10% [95% CI, 61%-79% BW]; p \ 0.001). Increasing polyethylene cup thickness increased deltoid force (3 mm: 65% ± 8% [95% CI, 56%-73% BW]; 9 mm: 68% ± 8% [95% CI, 61%-75% BW]; p = 0.03) and joint load (3 mm: 60% ± 8% [95% CI, 53%-67% BW]; 9 mm: 64% ± 10% [95% CI, 56%-72% BW

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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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Reverse shoulder arthroplasty in revision of failed shoulder arthroplasty—outcome and follow-up

Cited by 105 publications

References 40 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

Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

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

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