Outcomes using superior and posterior-superior augmented baseplates in reverse total shoulder arthroplasty for glenoid wear: short term follow up compared to match control

Aims The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23% to 109%). Both improved significantly (p < 0.001). The mean forward flexion was 104° (50° to 155°) and mean abduction was 98° (60° to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 minutes versus 102 minutes; p = 0.018). Conclusion After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. Cite this article: Bone Joint J 2018;100-B:761–6.

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Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00087 ◽

2021 ◽

Vol 24 (3) ◽

pp. 125-134

Author(s):

Kirtan Tankshali ◽

Dong-Whan Suh ◽

Jong-Hun Ji ◽

Chang-Yeon Kim

Keyword(s):

Los Angeles ◽

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

Intraoperative Complications ◽

Total Shoulder Arthroplasty ◽

Asian Population ◽

Reverse Total Shoulder Arthroplasty ◽

Scapular Notching ◽

Reverse Total Shoulder

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up.Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with a minimum of 2 years of follow-up were enrolled. We evaluated the preoperative and postoperative clinical outcomes, radiological outcomes (notching and loosening), and complications of BIO-RSA at the last follow-up. In addition, we divided these patients into notching and not-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients between the two groups.Results: Visual analog scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Simple Shoulder Test scores improved significantly from preoperative (average: 5, 39.43, 16.22, 3.94) to postoperative (average: 1.71, 78.91, 28.34, 7.8; p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20/38 patients (53%). In the comparison between notching and not-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications were three metaphyseal fractures and one inferior screw malposition. Postoperative complications included one heterotopic ossification, one scapula neck stress fracture, one humeral stem loosening, and one late infection.Conclusions: BIO-RSA resulted in improved clinical outcomes at mid-term follow-up in the Asian population. Although better cosmesis and advantages of glenoid lateralization were observed, we observed higher rates of scapular notching compared to previously reported rates in BIO-RSA studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

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Short term results of reverse total shoulder arthroplasty

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2019.08.008 ◽

2020 ◽

Vol 11 ◽

pp. S270-S274

Author(s):

Aditya K. Agrawal ◽

Carlos Wigderowitz ◽

Bruno Ribeiro ◽

Amar Malhas ◽

Abhishek Vaish ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Short Term ◽

Reverse Total Shoulder

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Near-simultaneous bilateral reverse total shoulder arthroplasty for the treatment of bilateral fracture dislocations of the shoulder

BMJ Case Reports ◽

10.1136/bcr-2019-230212 ◽

2019 ◽

Vol 12 (10) ◽

pp. e230212 ◽

Cited By ~ 1

Author(s):

Alexander Wendling ◽

Matthew L Vopat ◽

Shang-You Yang ◽

Bradley Saunders

Keyword(s):

Shoulder Arthroplasty ◽

Treatment Plan ◽

Total Shoulder Arthroplasty ◽

Reverse Total Shoulder Arthroplasty ◽

Left Shoulder ◽

Fracture Dislocations ◽

Bilateral Fracture ◽

Reverse Total Shoulder

A man in his mid-80s presented with bilateral posterior fracture dislocations of the humerus after suffering a seizure. He had Parskinson’s disease and lived with his wife at home. His left shoulder was not felt to be reconstructable. The initial treatment plan was to perform reverse total shoulder arthroplasty (rTSA) on the left and non-operatively reduce his right shoulder. A left rTSA was performed, but his right shoulder was unstable due to a glenoid fracture and soft tissue instability. In order to preserve the patient’s quality of life, a right rTSA was performed 4 days later. In the follow-up period, the patient was able to regain enough pain-free range of motion on activities of daily living. The patient died from complications of Parkinson’s disease 10 months postoperatively.

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