scholarly journals Revision of failed reverse shoulder arthroplasty—a point of no return?

2020 ◽  
Vol 15 (3) ◽  
pp. 187-198
Author(s):  
Frank Gohlke ◽  
Ayman A. Abdelkawi ◽  
Hani Eltair ◽  
Mohamed Aboalata ◽  
Walid Hussein ◽  
...  
Keyword(s):  
Bone Loss ◽  
Aseptic Loosening ◽  
Shoulder Arthroplasty ◽  
Failure Modes ◽  
Reverse Shoulder Arthroplasty ◽  
Chronic Infections ◽  
Main Indication ◽  
Modes Of Failure ◽  
Custom Made ◽  
Scapular Spine

Abstract Background The rate of complications after revision of reverse shoulder arthroplasty (RSA) is higher than it is in primary RSA, depending on the type of surgical intervention, the follow-up time, the preoperative condition of the patient, and the experience of the surgeon. Objective The current article represents an evaluation of the authors’ experiences with revisions of RSA and a review of literature, in order to define prognostic parameters and surgical options for the most common modes of failure. Materials and methods Between 2010 and 2019, 136 revisions of RSA were performed. Mean age of the patients at surgery was 68.3 years (29–88 years). The main indication was instability in 24 patients and chronic infection in 34. Aseptic loosening of the stem was the main indication in 15 and aseptic loosening of the baseplate in 23 patients. Periprosthetic fractures were present in 21 patients. Fractures of the scapular spine were operated on in 6 and surgery was performed for progressive notching due to malposition of the glenosphere in 4 patients. Results Staged procedures, use of allografts, and custom-made implants are common, especially for chronic infections and severe bone loss. Most of the patients (88.2%) were treated successfully. Two salvage procedures and two retentions of spacers occurred. We identified risk groups for re-revision: chronic dislocations, chronic infections, advanced bone loss, and scapular spine fractures. We observed a shift of indications and techniques, often related to the design of the implants. Conclusion These results confirm that careful preoperative planning, special implants, and a high level of experience are mandatory. With time, the authors developed an algorithm for certain indications because it was recognized that failures are often of multifactorial origin. Today, numerous implant designs which differ considerably in biomechanical features and failure modes are available. This makes revisions of RSA more complex than it was in the past.

scholarly journals Custom-made reverse shoulder arthroplasty for severe glenoid bone loss: review of the literature and our preliminary results

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
G. Porcellini ◽  
G. M. Micheloni ◽  
L. Tarallo ◽  
P. Paladini ◽  
G. Merolla ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Glenoid Bone Loss ◽  
Navigation Systems ◽  
Preliminary Results ◽  
The Past ◽  
Custom Made ◽  
Literature Evidence ◽  
Surgical Options

Abstract The treatment of severe glenoid bone loss in shoulder arthroplasty represents a challenge, and the results of current prosthetic designs with only glenoid fixation still remain unsatisfactory. In the past decade, customized glenoid prostheses have been developed to address severe glenoid arthritis and in the revision setting. In this review, we analyzed the current surgical options, the classification limits, past literature evidence, and our preliminary results of 6 patients (3 male, 3 female) treated with a reverse implant and custom-made glenoid implant (ProMade; LimaCorporate, Italy). Computer analysis of the residual shape and the amount of glenoid bone stock in association with new classifications could help the surgeon to obtain good clinical and radiological outcomes. The development of navigation systems could improve the adequacy of the implant and, thus, the reliability and longevity of the implant itself.

Benefits of a metallic lateralized baseplate prolonged by a long metallic post in reverse shoulder arthroplasty to address glenoid bone loss

2018 ◽  
Vol 43 (9) ◽  
pp. 2131-2139 ◽  
Author(s):  
Philippe Valenti ◽  
Johanna Sekri ◽  
Jean Kany ◽  
Imen Nidtahar ◽  
Jean-David Werthel
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Glenoid Bone Loss

Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review

2020 ◽  
pp. 175857322091765
Author(s):  
Betty Zhang ◽  
Gavinn Niroopan ◽  
Chetan Gohal ◽  
Bashar Alolabi ◽  
Timothy Leroux ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Bone Grafting ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Level Of Evidence ◽  
Total Shoulder Arthroplasties ◽  
Component Loosening ◽  
Shoulder Arthroplasties

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

scholarly journals Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

2020 ◽  
Vol 44 (12) ◽  
pp. 2673-2681
Author(s):  
Richard W. Nyffeler ◽  
Bartu Altioklar ◽  
Philipp Bissig
Keyword(s):  
Bone Quality ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Control Group ◽  
Time Interval ◽  
Spine Fractures ◽  
Poor Bone Quality ◽  
Significant Deterioration ◽  
Scapular Spine

Abstract Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.

scholarly journals Allograft-Prosthetic Composite Reconstruction for Massive Proximal Humeral Bone Loss in Reverse Shoulder Arthroplasty

2017 ◽  
Vol 99 (24) ◽  
pp. 2069-2076 ◽  
Author(s):  
Joaquin Sanchez-Sotelo ◽  
Eric R. Wagner ◽  
Franklin H. Sim ◽  
Matthew T. Houdek
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty

scholarly journals Reverse Shoulder Arthroplasty, Deltopectoral Approach vs. Anterosuperior Approach: An Overview of the Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Paraskevas Georgoulas ◽  
Aliki Fiska ◽  
Athanasios Ververidis ◽  
Georgios I. Drosos ◽  
Evanthia Perikleous ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Shoulder Arthroplasty ◽  
Large Scale ◽  
Reverse Shoulder Arthroplasty ◽  
Clinical Effectiveness ◽  
Surgical Approaches ◽  
Cuff Tear ◽  
Scapular Spine ◽  
Deltopectoral Approach

Reverse shoulder arthroplasty (RSA) has become an optimal treatment for numerous orthopedic entities, such as rotator cuff tear arthropathies, pseudoparalysis, fracture sequelae, acute fractures, failed arthroplasties, osteoarthritis, and rheumatoid arthritis, and is linked with relief of topical pain and regaining of functionality. Presently, RSA has been conducted through anterosuperior (AS) or deltopectoral (DP) approach. The aim of the study was to discuss both approaches and to examine broadly their features to render a comparison in terms of clinical effectiveness. An electronic search in PubMed, EMBASE, and Google Scholar databases was performed, using combinations of the following keywords: RSA, DP approach, AS approach, notching, and cuff tear arthropathy. A total of 61 studies were found, and 16 relevant articles were eventually included. Currently published literature has not shown significant diversities in the clinical course due to approach preference; risk of instability seems to be greater in DP approach, while regarding scapular notching and fracture rates the findings were conflicted. In addition, the AS approach has been associated with decreased risk of acromial and scapular spine fractures. In conclusion, both surgical approaches have shown similar clinical outcomes and effectiveness concerning pain and restoring range of motion (ROM) in rotator cuff tear arthropathies. In the future, further investigations based on large-scale well-designed studies are required to address clinical gaps allowing in-depth comparison of both approaches.

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