scholarly journals Outcome and complications following revision shoulder arthroplasty

2021 ◽  
Vol 2 (8) ◽  
pp. 618-630
Author(s):  
Vinayak Ravi ◽  
Richard James Murphy ◽  
Robert Moverley ◽  
Mina Derias ◽  
Joideep Phadnis
Keyword(s):  
Clinical Data ◽  
Revision Surgery ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Complication Rates ◽  
Continuous Variables ◽  
Intraoperative Complication ◽  
Patient Reported ◽  
Revision Shoulder Arthroplasty ◽  
Reoperation Rates

Aims It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery. Methods A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analyzed using a meta-analysis of proportion, and continuous variables underwent comparative subgroup analysis. Results A total of 112 studies (5,379 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (601/3,041), instability 19% (577/3,041), rotator cuff failure 17% (528/3,041), and infection 16% (490/3,041). Intraoperative complication and postoperative complication and reoperation rates were 8% (230/2,915), 22% (825/3,843), and 13% (584/3,843) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (91/230, 40%) and instability (215/825, 26%). Revision to reverse total shoulder arthroplasty (TSA), rather than revision to anatomical TSA from any index prosthesis, resulted in lower complication rates and superior Constant scores, although there was no difference in American Shoulder and Elbow Surgeons scores. Conclusion Satisfactory improvement in patient-reported outcome measures are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA. Cite this article: Bone Jt Open 2021;2(8):618–630.

scholarly journals 654 Outcome and Complications Following Revision Shoulder Arthroplasty. A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Ravi ◽  
R Murphy ◽  
R Moverley ◽  
M Derias ◽  
J Phadnis
Keyword(s):  
Systematic Review ◽  
Clinical Data ◽  
Revision Surgery ◽  
Shoulder Arthroplasty ◽  
Meta Analysis ◽  
Complication Rates ◽  
Intraoperative Complication ◽  
Patient Reported ◽  
Revision Shoulder Arthroplasty ◽  
Reoperation Rates

Abstract Introduction It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on (i) shoulder outcome scores, (ii) complication and reoperation rates and (iii) comparison of anatomic and reverse prostheses when used in revision surgery. Method A PRISMA systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analysed using a meta-analysis of proportion and continuous variables underwent comparative subgroup analysis. Results 107 studies (5,010 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (n = 584/2872), instability 20% (n = 577/2872), rotator cuff failure 18% (n = 528/2872) and infection 17% (n = 490/2872). Revision surgery resulted in a clinically important improvement in patient-reported outcome measures (PROMs). Intraoperative complication, postoperative complication and reoperation rates were 3% (n = 205/4919), 22% (n = 722/3474) and 15% (n = 533/3474) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (n = 134/205, 65%) and instability (n = 209/772, 27%). Revision to reverse TSA, rather than revision to anatomic TSA from any index prosthesis resulted in lower complication rates (22% vs. 29%, p < 0.001 odds ratio 1.5) and superior Constant scores (59.9 vs. 53.8, p < 0.001), although no difference in ASES scores. Conclusions Satisfactory improvement in PROMs are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA.

Reverse total shoulder arthroplasty

2021 ◽  
pp. 1-9
Author(s):  
Eleanor G. Burden ◽  
Timothy J. Batten ◽  
Christopher D. Smith ◽  
Jonathan P. Evans
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Implant Design ◽  
Complication Rates ◽  
Scapular Notching ◽  
Cuff Tear ◽  
Patient Reported ◽  
Reverse Total Shoulder

Aims This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH). Methods A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde’s non-summative four-point system. The study was registered with PROSPERO (CRD42020193041). Results A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies. Conclusion This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design.

Anatomic Total Shoulder Arthroplasty With a Stemless Humeral Component

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542199712
Author(s):  
Jordan D. Walters ◽  
Stephen F. Brockmeier
Keyword(s):  
Bone Quality ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Complication Rates ◽  
Lesser Tuberosity ◽  
Critical Elements ◽  
Implant Placement ◽  
Humeral Component ◽  
Component Loosening ◽  
Deltopectoral Approach

Background: This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications: Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description: Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure’s critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion: Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.

Anatomic versus reverse shoulder arthroplasty: a mid-term follow-up comparison

2020 ◽  
pp. 175857322092115
Author(s):  
Bradley S Schoch ◽  
Joseph J King ◽  
Joseph Zuckerman ◽  
Thomas W Wright ◽  
Chris Roche ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reoperation Rate ◽  
Patient Reported ◽  
Total Shoulder Arthroplasties ◽  
Shoulder Arthroplasties

Background Anatomic total shoulder arthroplasty improves pain and function with a reported reoperation rate of approximately 1% per year. With improved glenoid fixation, reverse shoulder arthroplasty implants may outperform anatomic total shoulder arthroplasty. We evaluate the functional outcomes and reoperation rate of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty at a minimum eight-year follow-up or revision. Methods Between 2005 and 2010, 187 shoulders (137 anatomic total shoulder arthroplasty, 50 reverse shoulder arthroplasty) were retrospectively reviewed at a mean of 8.8 years. The mean age at surgery was 67 years. Females were more commonly treated with reverse shoulder arthroplasty. Both groups had similar body mass index and comorbidities. Outcome measures evaluated included abduction, forward elevation, external rotation, internal rotation, Simple Shoulder Test, Constant score, American Shoulder and Elbow Score, University of California Los Angeles Shoulder score, and Shoulder Pain and Disability Index. Results At follow-up, anatomic total shoulder arthroplasty demonstrated greater overhead range of motion and external rotation. All patient-reported outcomes remained similar between groups. Reverse shoulder arthroplasty patients were more likely to rate shoulders as much better or better after surgery (90% versus 67%, p = 0.004). Complications were observed in 24% of anatomic total shoulder arthroplasties and 8% of reverse shoulder arthroplasties (p = 0.02). Reoperation was more common in anatomic total shoulder arthroplasties (23% versus 4%, p = 0.003). Discussion At mid-to-long-term follow-up, reverse shoulder arthroplasties demonstrated significantly fewer complications and reoperations than anatomic total shoulder arthroplasties. Despite similar patient-reported outcomes, reverse shoulder arthroplasty patients were more likely to be satisfied with their shoulder.

Effect of deltoid volume on range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions

2020 ◽  
pp. 175857322092504
Author(s):  
Samuel G McClatchy ◽  
Griffin M Heise ◽  
William M Mihalko ◽  
Frederick M Azar ◽  
Richard A Smith ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Deltoid Muscle ◽  
Reverse Total Shoulder Arthroplasty ◽  
Shoulder Range Of Motion ◽  
Patient Reported ◽  
Reverse Total Shoulder

Background Deltoid muscle function is paramount to the success of reverse total shoulder arthroplasty. The purpose of this study was to investigate the role of deltoid volume on shoulder range of motion and patient-reported outcomes following reverse total shoulder arthroplasty in rotator cuff-intact and rotator cuff-deficient conditions. Methods Retrospective review of records identified 107 patients who met inclusion criteria. The rotator cuff integrity was evaluated by two musculoskeletal-trained radiologists. Volumetric deltoid measurements were calculated from preoperative computed tomography or magnetic resonance imaging scans. Satisfactory outcomes were defined as forward elevation of at least 135°, external rotation of at least 35°, and American Shoulder and Elbow Surgeons and Single Assessment Numerical Evaluation scores of at least 70. Results Mean total deltoid muscle volume was significantly higher in patients with satisfactory forward elevation (57.8 ± 18.1 cm³) versus unsatisfactory forward elevation (48.6 ± 19.5 cm³) (p = 0.013). When separated by rotator cuff integrity, total deltoid volume was significantly higher (p = 0.030) in patients who achieved satisfactory forward elevation in the rotator cuff-deficient group but not the rotator cuff-intact group (p = 0.533). Discussion Preoperative deltoid volume directly correlated with achieving satisfactory forward elevation after reverse total shoulder arthroplasty in rotator cuff-deficient conditions and may be one factor in determining the ability to achieve satisfactory outcomes in the rotator cuff-deficient patient.

Anatomic total shoulder arthroplasty in rheumatoid arthritis: A systematic review

2020 ◽  
pp. 175857322095415
Author(s):  
Ahmed Haleem ◽  
Ajaykumar Shanmugaraj ◽  
Nolan S. Horner ◽  
Timothy Leroux ◽  
Moin Khan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Significant Heterogeneity ◽  
Tissue Quality ◽  
Patient Reported ◽  
Clinically Significant ◽  
Reverse Total Shoulder

Purpose Given the poor soft-tissue quality in rheumatoid arthritis patients, many believe that rheumatoid arthritis should be treated with reverse total shoulder arthroplasty (rTSA). The purpose of this paper is to systematically assess outcomes of anatomic total shoulder arthroplasty (aTSA) in rheumatoid arthritis to determine if aTSA remains a viable option. Methods A comprehensive literature search was conducted identifying articles relevant to aTSA in the setting of rheumatoid arthritis with intact rotator cuff. Outcomes include clinical outcomes and rates of complication and revision. Results Ten studies were included with a total of 279 shoulders with mean follow-up of 116 ± 69 months. The mean age was 68 ± 10 years. Survivorship was 97%, 97% and 89% at 5, 10 and 20 years, respectively. The overall complication rate was 9%. Radiolucency was present in 69% of patients, of which 34% were at risk of loosening at 79 months. The overall rate of revision was 8.4%. Studies generally reported clinically significant improvements in range of motion, Constant score and ASES score. Conclusion aTSA in the rheumatoid patient results in improvements in range of motion and patient-reported outcomes. Rates of complications and survivorship are generally good in this population. However, it should be noted that there is significant heterogeneity in outcome reporting amongst the literature on this topic and that many studies fail to adequately report complication and revision rates. When compared to rTSA in patients with rheumatoid arthritis, evidence suggests that aTSA is still a viable treatment option despite the shift in utilization to rTSA.

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