The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty

Walker, M.; Willis, Matthew; Brooks, Jordan; Pupello, Derek; Mulieri, Philip J.; Frankle, Mark A.

doi:10.1016/j.jse.2011.03.006

Cited by 159 publications

(109 citation statements)

References 21 publications

(26 reference statements)

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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%

“…If revision of a failed hemiarthroplasty or total shoulder arthroplasty is uncertain to preserve or restore satisfactory rotator cuff function, conversion to a reverse total shoulder arthroplasty is the most reliable surgical option to restore overhead function [8,20,21,23,33] and therefore has become the preferred treatment, at least for elderly patients. Such revisions, however, are associated with the risk of intraoperative and/or postoperative complications [8,12,18,20,21,23,26,27,32,33].…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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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