Reverse shoulder arthroplasty with a short metaphyseal humeral stem

Abstract

Purpose Reverse shoulder prostheses have been gaining popularity in recent years. A short metaphyseal stem design will allow bone stock preservation and minimize stem related complications. We examined the clinical and radiographic short-term outcome of a short metaphyseal stem reverse shoulder arthroplasty. Methods Thirty-one patients, with a mean follow-up of 36 months (24-52), were evaluated clinically with the Constant-Murley score, patient satisfaction and pain relief scores. The fixation of the glenoid and humeral components, subsidence and notching were evaluated on radiographs. The indications were cuff tear arthropathy (22), fracture sequelae (five) and rheumatoid arthritis (four). Results The average Constant score improved from 12.7 (range two to 31) pre-operatively to 56.2 (range 17-86) postoperatively. It rose from 13.5 to 58.3 in patients with Cuff arthropathy, from 15.8 to 62.0 in revision arthroplasty, from 10.2 to 47.4 in those with fracture sequelae, and from 11.5 to 55.3 in patients with rheumatoid arthritis. The overall mean patient satisfaction score improved from 2.4/10 to 8.5/10 and mean pain score improved from 0.8/15 to 12.5/15. We found an overall improvement in active forward flexion from 46.8 to 128.5°and from 41.6 to 116.5°in abduction. No humeral loosening or subsidence was observed. Two cases of grade 1-2 glenoid notching were reported. Overall there were three intra-operative fractures that did not affect the operation and healed without affecting the good results. There were five late traumatic periprosthetic fractures, only one of them required a revision surgery to a stemmed implant and the rest healed without surgery. There were two early dislocations that had to be revised. Conclusions The clinical and radiographic evaluation of a bone preserving metaphyseal humeral component in reverse shoulder arthroplasty is promising, with good clinical results, no signs of loosening or subsidence.

Complications of Shoulder Arthroplasty

“…Raiss et al demonstrated a reduction in survivorship at 10 and 15 years after TSA performed with cement secondary to pain and implant loosening; revision procedures occurred at a mean of 8.8 years from the date of implantation 125 . The five RSA studies with minimum follow-up of 5 years noted scapular notching and instability as the most common complications 28 [33][34][35][36][37][38][39][44][45][46][47][48]50,51,53,54,[56][57][58][59]61,64,65,67,69,70,73,75,79,81,[88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]104,105,…”

Stemless shoulder prosthesis for treatment of proximal humeral malunion does not require tuberosity osteotomy

“…Anatomic stemless prostheses have been shown to provide good functional outcomes that are comparable to those of a stemmed prosthesis, with excellent bone fixation and without radiolucent lines or loosening [14,15]. Even in the reverse configuration, studies report good results without loosening [12,16,17]. Anatomic stemless prostheses help to restore the pre-operative proximal humerus anatomy [18].…”

A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty

“…The humeral component can be stemmed, short-stemmed [64, 65], or stemless [66]. The series with stemless prostheses present equal results as the stemmed ones.…”