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Katayama ES, Barry LW, Barnett JS, Iyer AI, Patel AV, Bishop JY, Cvetanovich GL, Rauck RC. Functional outcomes and survivorship following aseptic revision shoulder arthroplasty. J Orthop 2024; 54:51-56. [PMID: 39036809 PMCID: PMC11259648 DOI: 10.1016/j.jor.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 03/13/2024] [Indexed: 07/23/2024] Open
Abstract
Background Revision shoulder arthroplasty (SA) is a surgical procedure performed to address complications or failures of primary total SA. However, limited evidence exists regarding the functional outcomes and longevity of implants following revision. Methods A retrospective analysis was conducted on patients who underwent revision SA for failed primary arthroplasty at a single institution between 2009 and 2021 with a minimum of 2-years follow-up. Data was collected from medical records, including type of arthroplasty (anatomic total SA [TSA], reverse total SA [RSA], or hemi-SA [HSA]), demographics and patient-specific information, functional measurements, and implant survival. Patient reported outcomes were obtained during follow-up by phone. Results The mean age at index and revision surgeries was 60.5 ± 12.1 years and 64.8 ± 11.1 years, respectively, and average total follow-up was 5.5 ± 3.5 years. The average time to revision was 4.5 ± 5.2 years (range 0.01-24.5 years). Among 99 revision shoulder arthroplasty procedures, 28 were TSA/HA to TSA/HA, 51 were TSA/HA to RSA, 18 were RSA to RSA, and 2 were RSA to HA. Revision surgery significantly improved functional outcomes in forward elevation (preoperative: 79.8 ± 41.0 vs postoperative: 118.5 ± 38.3; p < 0.001), external rotation (preoperative: 27.8 ± 19.3 vs postoperative: 34.3 ± 16.2; p = 0.028), internal rotation (preoperative: glute vs postoperative: S1; p = 0.002), and forward elevation strength (preoperative: 4+/5 vs postoperative: 5/5; p = 0.002). Postoperative patient reported outcomes included: VAS pain (2.2 ± 2.9), SANE (72.6 ± 21.5), ASES (73.3 ± 20.4), and SST (7.7 ± 2.8) scores. The overall 2-, 5-, and 10-year post-revision implant survival rate was 85.48%, 83.06%, and 79.84%, respectively. Patients who had an initial RSA and were revised to RSA were at higher risk of implant failure and subsequent re-revision (RSA to RSA: 1.5 ± 2.5 years vs. TSA/HA to RSA: 2.5 ± 2.1 years vs. TSA/HA to TSA/HA: 4.0 ± 3.5 years; p = 0.0046). Conclusion Revision shoulder arthroplasty improved patient outcomes post-index arthroplasty failure. Revisions were more likely to be successful when revising from TSA/HA to RSA. Level of evidence Level III - retrospective comparative study.
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Affiliation(s)
- Erryk S. Katayama
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Louis W. Barry
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John S. Barnett
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Amogh I. Iyer
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Akshar V. Patel
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie Y. Bishop
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gregory L. Cvetanovich
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ryan C. Rauck
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
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Walch A, Edwards TB, Kilian CM, Boileau P, Walch G, Athwal GS. Hemi-reverse revision arthroplasty in the setting of severe glenoid bone loss. J Shoulder Elbow Surg 2022; 31:1859-1873. [PMID: 35339707 DOI: 10.1016/j.jse.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid bone loss is one of the main challenges in revision of failed shoulder arthroplasties. The concept of a hemi-reverse procedure is to implant a glenoid baseplate and glenosphere to protect the glenoid reconstruction to allow it to heal and to preserve the joint space for a potential second-stage humeral component implantation. The purpose of this study was to report the results of hemi-reverse procedures. METHODS Revision to a hemi-reverse procedure was performed in 15 patients: 8 with a failed anatomic total shoulder arthroplasty, 3 with a failed reverse shoulder arthroplasty, 3 with a failed humeral hemiarthroplasty, and 1 with placement of a cement spacer owing to sepsis after a total shoulder arthroplasty. After complete removal of the initial prosthesis, all patients underwent glenoid reconstruction with bone grafting and implantation of a reverse arthroplasty baseplate and glenosphere. A humeral implant was not placed in any case. The patients were prospectively followed up and underwent complete clinical and radiologic studies preoperatively and postoperatively at a minimum of 2 years after the surgical procedure. RESULTS Thirteen hemi-reverse implants and glenoid bone grafts healed (86%) and remained radiographically stable. One hemi-reverse construct migrated and became mechanically loose, which was attributed to absent fixation of the central post in the native glenoid bone. In 1 patient, an implant-related infection developed; irrigation and debridement were performed, in addition to revision to a resection arthroplasty. After documented radiographic healing of the hemi-reverse glenoid reconstruction, 5 patients underwent a second-stage revision to a reverse procedure with insertion of a humeral component at a median of 6 months (interquartile range [IQR], 6-8 months). In this group, the median follow-up period was 73 months (IQR, 45-153 months), the median Constant score was 48 (IQR, 41-56), median active forward elevation was 135° (IQR, 100°-150°), and the median Subjective Shoulder Value was 50% (IQR, 50%-60%). In the group of 9 patients with remaining hemi-reverse implants, the median follow-up period was 38 months (IQR, 29-60 months), the median Constant score was 41 (IQR, 38-46), median active forward elevation was 100° (IQR, 80°-100°), and the median Subjective Shoulder Value was 50% (IQR, 40%-60%). CONCLUSION The hemi-reverse procedure is an effective revision procedure to reconstruct a severely deficient glenoid. The hemi-reverse procedure may function as the definitive procedure, with satisfactory outcomes. Additionally, in patients who undergo the hemi-reverse procedure, second-stage revision to a total reverse procedure can be performed once imaging confirms bone graft and construct stability.
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Affiliation(s)
- Arnaud Walch
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France.
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | | | | | | | - George S Athwal
- Roth|McFarland Hand and Upper Limb Center, Western University, St Joseph's Health Care London, London, ON, Canada
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Kriechling P, Andronic O, Wieser K. Hemiarthroplasty as a salvage treatment for failed reverse total shoulder arthroplasty. JSES Int 2021; 5:1055-1061. [PMID: 34766084 PMCID: PMC8568842 DOI: 10.1016/j.jseint.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The implantation rates of reverse total shoulder arthroplasties (RTSAs) are increasing worldwide, resulting in higher absolute numbers of the associated complications and revision surgeries. This requires the discussion of salvage therapies for failed RTSAs without revision to a new RTSA. Revision to hemiarthroplasty may offer a valid fallback option in certain cases. This study aimed to analyze the incidence, indications, and clinical outcomes, especially the reduction in pain levels compared to a matched control group. Methods Our prospectively enrolled patient cohort of RTSA implantations at a tertiary referral center between January 2005 and December 2018 was retrospectively queried for revision to a hemiarthroplasty. For clinical outcome evaluation, a minimum follow-up duration of 2 years after revision to hemiarthroplasty was required. Clinical outcome measures were compared to two matching groups, one with RTSA preserving revision and one without any reintervention. The outcome measures were the absolute and relative Constant-Murley score (aCS and rCS), Subjective Shoulder Value (SSV), range of motion, and pain. Results A total of 21 out of 1237 RTSAs (1.7%) underwent salvage revision to hemiarthroplasty at a mean time of 20 ± 21 months (range, 1-75 months). Of those, 12 were available for a minimum follow-up of 2 years after revision to a hemiarthroplasty. The main indications were glenoid loosening (8/12), scapular spine fracture (2/12), and instability (2/21). Clinical outcome was analyzed at a mean follow-up period of 46 ± 26 months (24 months to 123 months) after revision to a hemiarthroplasty. The revision significantly reduced CS pain from 6 ± 4 points to 12 ± 3 points (scale 0 to 15 with 15 as optimum, P < .01). The aCS, rCS, SSV, and range of motion did not improve. Comparison with the RTSA preserving revision group and the RTSA group without reintervention showed significantly worse outcome scores for aCS (33 ± 10 vs. 55 ± 19 vs. 69 ± 12 points), rCS (41 ± 14% vs. 67 ± 20% vs. 84 ± 13%), SSV (35 ± 19% vs. 64 ± 20% vs. 81 ± 15%), flexion (53 ± 27° vs. 64 ± 20° vs. 128 ± 24°), and abduction (50 ± 23° vs. 109 ± 42° vs. 142 ± 24°). Pain was similar in all groups at the last follow-up visit. Conclusion In a few cases, RTSA retention or revision to another RTSA is impossible. For those patients, conversion to hemiarthroplasty is a valid fallback option to reduce the patient's pain levels and provide low-level function.
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Affiliation(s)
- Philipp Kriechling
- Corresponding author: Philipp Kriechling, MD, Forchstrasse 340, 8008 Zürich, Switzerland.
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Heifner JJ, Kumar AD, Wagner ER. Reverse shoulder arthroplasty used for revision of reverse shoulder arthroplasty: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:329-334. [PMID: 37588710 PMCID: PMC10426696 DOI: 10.1016/j.xrrt.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background As reverse shoulder arthroplasty (RSA) cases increase, so too will the need to revise subsequent failures. Many of the complications associated with revising anatomic total shoulder and hemiarthroplasty have been adequately addressed by RSA including glenoid bone deficiency, instability, and functional outcomes. However, the risk for complication when revising a failed reverse prosthesis may be more pronounced with increased bone and soft tissue deficiency. The ability for the reversed prosthesis to accommodate these insufficiencies following a prior reversed prosthesis is unclear. Methods PubMed, Embase, and Google Scholar were queried for articles which fit the inclusion criteria of a reversed prosthesis used to revise a failed primary reverse prosthesis with a minimum follow-up of 12 months and clinical outcome reporting. Results After exclusions, 9 studies reporting on 242 reverse shoulders with a mean follow-up of 40.29 months were analyzed. The differences between preoperative and postoperative weighted means were not significant for Constant (P = .26), American Shoulder and Elbow Surgeons Shoulder score (P = .61), SSV (P = .57), and visual analog scale for pain (P = .48). Functional improvements in elevation (74°-102°) and external rotation (18°-21°) were consistent with those reported for primary reverse procedures, although differences in preoperative and postoperative measures were not statistically significant. Patient satisfaction was 89% with a major complication rate of 25%. Discussion The reverse shoulder prosthesis has proven satisfactory in revising hemiarthroplasty and anatomic total shoulder arthroplasty. The current results indicate RSA is also a satisfactory treatment option when revising a prior reverse prosthesis. Inherent to revision shoulder surgery is the obstacle of humeral and glenoid bone loss, an attenuated soft-tissue envelope, and instability. The reverse prosthesis may adequately address these commonly confronted difficulties with its inherent design characteristics. RSA provides a secure glenoid fixation for bone grafting, the ability to increase construct stability with component sizing, and a reliance on the deltoid for function. As our learning about revision of RSA improves, so will our ability to preemptively address potential issues which may lead to decreased complications in these cases. Despite the 25% rate of major complication, patients reported satisfaction of 89% which demonstrates the improvements in function and pain relief that are provided by the reverse prosthesis.
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Affiliation(s)
| | - Anjali D. Kumar
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric R. Wagner
- Division of Upper Extremity Surgery, Department of Orthopaedic Surgery, Director of Upper Extremity Surgery Research, Atlanta, GA, USA
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Erickson BJ. Failed Reverse Total Shoulder Arthroplasty: What Are Our Bailouts? Curr Rev Musculoskelet Med 2021; 14:291-296. [PMID: 34406603 PMCID: PMC8497668 DOI: 10.1007/s12178-021-09712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW As the population continues to age and indications continue to expand, the number of reverse total shoulder arthroplasty (RSTA) procedures has increased significantly. While RTSA is an effective solution to many shoulder problems, it is not without complications. Furthermore, as the number of RTSA procedures increases, so will the number of complications following this procedure. While some complications can be managed with revision RTSA, there are some complications that, unfortunately, cannot. The purpose of this review is to discuss the revision options for failed RTSA. RECENT FINDINGS While there has been a significant amount of recent literature surrounding RTSA, much of this literature has been aimed at improving outcomes for primary RTSA by improving glenoid placement, maximizing range of motion, etc., or improving outcomes following conversion of another surgery to RTSA [1••, 2, 3]. There has been little evidence surrounding options for failed RTSA that cannot be salvaged to a revision RTSA. These options are limited and often involve resection arthroplasty and hemiarthroplasty, although neither option provides patients with significant function of the shoulder [4, 5•]. Complications following RTSA are becoming more common as the number of RTSA continues to increase. Furthermore, as the indications for RTSA expand, the complications will continue to increase as this implant is used to tackle more difficult problems about the shoulder. When possible, the etiology of the problem with the RTSA should be addressed and may involve component revision, bone grafting, etc. When the problem cannot be solved with revision RTSA, then the patient can be converted to a hemiarthroplasty, or have a resection arthroplasty, with the understanding that their shoulder function will be limited.
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Affiliation(s)
- Brandon J Erickson
- Rothman Orthopaedic Institute, 645 Madison Ave, New York, NY, 10022, USA.
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Suroto H, De Vega B, Deapsari F, Prajasari T, Wibowo PA, Samijo SK. Reverse total shoulder arthroplasty (RTSA) versus open reduction and internal fixation (ORIF) for displaced three-part or four-part proximal humeral fractures: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:941-955. [PMID: 34760293 PMCID: PMC8559569 DOI: 10.1302/2058-5241.6.210049] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Despite rapid medical technology development, various challenges exist in three- and four-part proximal humeral fracture (PHF) management. This condition has led to a notably increased use of the reverse total shoulder arthroplasty (RTSA); however, open reduction and internal fixation (ORIF) is still the most widely performed procedure. Thus, these two modalities are crucial and require further discussion. We aim to compare the outcomes of three- or four-part PHF surgeries using ORIF and RTSA based on direct/head-to-head comparative studies.We conducted a systematic review and meta-analysis based on the Cochrane handbook and PRISMA guidelines. We searched MEDLINE (PubMed), Embase (Ovid), and CENTRAL (Cochrane Library) from inception to October 2020. Our protocol was registered at PROSPERO (registration number CRD42020214681). We assessed the individual study risk of bias using ROB 2 and ROBINS-I tools, then appraised our evidence using the GRADE approach.Six head-to-head comparative studies were included, comprising one RCT and five retrospective case-control studies. We found that RTSA significantly improved forward flexion but was comparable to ORIF in abduction (p = 0.03 and p = 0.47, respectively) and more inferior in external rotation (p < 0.0001). Moreover, RTSA improved the overall Constant-Murley score, but the difference was not significant (p = 0.22). Interestingly, RTSA increased complications (by 42%) but reduced the revision surgery rates (by 63%) compared to ORIF (p = 0.04 and p = 0.02, respectively).RTSA is recommended to treat patients aged 65 years or older with a three- or four-part PHF. Compared to ORIF, RTSA resulted in better forward flexion and Constant-Murley score, equal abduction, less external rotation, increased complications but fewer revision surgeries. Cite this article: EFORT Open Rev 2021;6:941-955. DOI: 10.1302/2058-5241.6.210049.
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Affiliation(s)
- Heri Suroto
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
- These authors contributed equally to this work
| | - Brigita De Vega
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
- These authors contributed equally to this work
| | - Fani Deapsari
- Cell & Tissue Bank-Regenerative Medicine Centre, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tabita Prajasari
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
| | - Pramono Ari Wibowo
- Department of Orthopaedics & Traumatology, Dr. Soetomo General Hospital / Universitas Airlangga, Surabaya, Indonesia
| | - Steven K. Samijo
- Department of Orthopaedics and Traumatology Zuyderland Medisch Centrum, Heerlen, the Netherlands
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Croucher J, Mahomed A. Concept and simulation of an alternative design for an orthopaedic shoulder implant. J Med Eng Technol 2021; 46:1-15. [PMID: 34549681 DOI: 10.1080/03091902.2021.1967489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
For a first-time glenohumeral arthritis patient, total shoulder arthroplasty (TSA) is an option where the shoulder joint is replaced with an artificial humeral head that articulates against a cup attached to the glenoid. A patient with rotator cuff deficiency can undergo reverse total shoulder arthroplasty (RTSA) where the components are switched. Presented here is a concept design at simulation stage which offers a platform-based implant where either a system can be assembled and implanted for TSA or a reverse system for RTSA. Platform components and the glenoid baseplate have been designed as part of this concept stage. Modular components are also described as part of the concept, which can influence a patient's range of motion (ROM), as well as the effect of implant positioning within the patient. A 42 mm hemisphere is used as the articulating component providing a good balance between ROM, joint load and deltoid force. The most suitable material concluded for the concept design TSA was as follows: grade 5 Ti-6Al-4V for the humeral stem and baseplate and CoCrMo with cross-linked polyethylene (XLPE) for the metal-on-polymer bearing surface. Finite element analysis concluded that the concept prosthesis is able to withstand an impact force of six times bodyweight from a forward fall. A dynamic fatigue test concluded that the expected lifetime of the concept polymer bearing surface is 33 years.
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Affiliation(s)
- James Croucher
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
| | - Aziza Mahomed
- Department of Mechanical Engineering, University of Birmingham, Birmingham, UK
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8
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Nielsen KP, Amundsen A, Olsen BS, Rasmussen JV. Good long-term patient-reported outcome after shoulder arthroplasty for cuff tear arthropathy. JSES Int 2021; 6:40-43. [PMID: 35141674 PMCID: PMC8811402 DOI: 10.1016/j.jseint.2021.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The use of the reverse shoulder arthroplasty (RSA) for cuff tear arthropathy (CTA) has increased within the last decades, but there is still limited information about the long-term outcome and how it performs in comparison with hemiarthroplasty (HA). The aim of this study was to compare the long-term patient-reported outcomes of RSA and HA for CTA. Methods We included all patients with CTA, who according to the Danish Shoulder Arthroplasty Registry, underwent either HA or RSA between 2006 and 2010. Patients who were alive were sent the Western Ontario Osteoarthritis of the Shoulder (WOOS) questionnaire in 2020. One hundred twenty (65%) patients returned a complete questionnaire. The linear regression model was used to compare RSA and HA. Sex, age, and previous surgery were included in the multivariable model. Results Forty-two HAs and 78 RSAs were evaluated with a mean follow-up time of 11.5 and 10.6 years, respectively. The mean WOOS score was 66.7 for HA and 71.7 for RSA. The difference of 5.0 was neither statistically significant nor clinically important (95% confidence interval: -4.3 to 14.2, P = .17), nor were there any significant risk of a worse WOOS score for sex, age, or previous surgery. Conclusion To our knowledge, this is the first study to compare the long-term patient-reported outcomes of HA and RSA for CTA. Our results indicate that RSA is a reliable and durable treatment option for CTA with good long-term results. Based on this observational study, it is not possible to make safe estimates about the effect of RSA compared with HA, but similar to RSA, HA was associated with relatively good long-term results.
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Affiliation(s)
- Karoline P. Nielsen
- Corresponding author: Karoline P. Nielsen, MD, Friheds Alle 34, 6400 Sønderborg, Denmark.
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Ravi V, Murphy RJ, Moverley R, Derias M, Phadnis J. Outcome and complications following revision shoulder arthroplasty : a systematic review and meta-analysis. Bone Jt Open 2021; 2:618-630. [PMID: 34382837 PMCID: PMC8384442 DOI: 10.1302/2633-1462.28.bjo-2021-0092.r1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Vinayak Ravi
- Brighton and Sussex Medical School, Brighton, UK
| | - Richard James Murphy
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
| | - Robert Moverley
- University Hospitals Dorset NHS Foundation Trust, Poole Hospital, Poole, UK
| | - Mina Derias
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
| | - Joideep Phadnis
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK
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Marzel A, Schwyzer HK, Kolling C, Moro F, Flury M, Glanzmann MC, Jung C, Wirth B, Weber B, Simmen B, Scheibel M, Audigé L. The Schulthess local Shoulder Arthroplasty Registry (SAR): cohort profile. BMJ Open 2020; 10:e040591. [PMID: 33243805 PMCID: PMC7692837 DOI: 10.1136/bmjopen-2020-040591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Clinical registries are essential for evaluation of surgical outcomes. The Schulthess Shoulder Arthroplasty Registry (SAR) was established in 2006 to evaluate safety, function, quality-of-life and patient satisfaction in patients undergoing shoulder arthroplasty. PARTICIPANTS Adult patients undergoing anatomic or reverse shoulder joint replacement at the Schulthess Klinik, a high-volume, leading orthopaedic surgery centre in Zürich, Switzerland. FINDINGS TO DATE Between March 2006 and December 2019, the registry covered 98% of eligible operations. Overall, 2332 patients were enrolled with a total of 2796 operations and 11 147 person-years of follow-up. Mean age at baseline was 71 (range: 20-95), 65% were women. Most common indication was rotator cuff tears with osteoarthritis (42%) and the mean preoperative Constant Score was 31 (±15). The most frequent arthroplasty type was reverse, increasing from 61% in 2006-2010 to 86% in 2015-2019. Functional recovery peaked at 12-month postoperatively and did not show a clinically relevant deterioration during the first ten follow-up years. Since its establishment, the registry was used to address multiple pertinent clinical and methodological questions. Primary focus was on comparing different implant configurations (eg, glenosphere diameter) and surgical techniques (eg, latissimus dorsi transfer) to maximise functional recovery. Additionally, the cohort contributed to the determination of the clinical relevance and validity of radiological monitoring of cortical bone resorption and scapular notching. Finally, SAR data helped to demonstrate that returning to sports was among key patient expectations after reverse shoulder arthroplasty. FUTURE PLANS As first patients are approaching the 15 years follow-up landmark, the registry will continue providing essential data on long-term functional outcomes, implant stability, revision rates and aetiologies as well as patient satisfaction and quality-of-life. In addition to research and quality-control, the cohort data will be brought back to the patients by bolstering real-time clinical decision support.
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Affiliation(s)
- Alex Marzel
- Research, Teaching and Development, Schulthess Klinik, Zurich, Switzerland
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Fabrizio Moro
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Matthias Flury
- Center for Orthopaedics and Neurosurgery, In Motion, Zurich, Switzerland
| | | | - Christian Jung
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Barbara Wirth
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Beatrice Weber
- Research, Teaching and Development, Schulthess Klinik, Zurich, Switzerland
| | - Beat Simmen
- Endoclinic, Hirslanden Clinic, Zurich, Switzerland
| | - Markus Scheibel
- Shoulder and Elbow Surgery, Schulthess Klinik, Zurich, Switzerland
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - Laurent Audigé
- Research, Teaching and Development, Schulthess Klinik, Zurich, Switzerland
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Abstract
Today, the treatment of osteoarthritis in the rotator cuff–deficient population is largely dominated by reverse shoulder arthroplasty (RSA). Despite the popularity of and increased familiarity with this procedure, the complication rate of RSA remains significant. An extended humeral head hemiarthroplasty may provide a less invasive alternative for select patients with cuff tear arthropathy (CTA) and preserved glenohumeral active elevation. With the indications for reverse arthroplasty expanding to younger patients, there are concerns about the longevity of this implant, as well as the associated revision burden. In the setting of failed RSA, the bone stock available for glenosphere baseplate fixation can be inadequate for reimplantation. The treatment strategies for complex shoulder deformities and failed RSA are limited by patient-specific issues, such as anatomy and risk factors. In this review, we discuss the potential role of extended humeral head hemiarthroplasty (CTA hemiarthroplasty) as a primary surgical option in select patients (1) who have preserved elevation > 90°, (2) who have maintained stability (intact coracoacromial ligament), and (3) who desire to circumvent the complications associated with RSA. Furthermore, CTA hemiarthroplasty may be used for severe glenoid erosion, for a fragmented acromion, and in the revision setting for failed RSA aimed at a reliable salvage procedure.
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Knowles NK, Columbus MP, Wegmann K, Ferreira LM, Athwal GS. Revision shoulder arthroplasty: a systematic review and comparison of North American vs. European outcomes and complications. J Shoulder Elbow Surg 2020; 29:1071-1082. [PMID: 32147336 DOI: 10.1016/j.jse.2019.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Joint registries provide invaluable data on primary arthroplasties with revision as the endpoint; however, the revision outcomes are often excluded. Therefore, a PROSPERO registered review (CRD42015032531) of all revision studies in North America and Europe was conducted to evaluate demographics, etiologies and indications, implant manufacturer, and complications by geographic region. METHODS The MEDLINE, EMBASE, and CENTRAL databases were searched for revision arthroplasty clinical studies with a minimum mean 24-month follow-up. There were no language exclusions. Articles published in German, French, and Italian were reviewed by research personnel proficient in each language. RESULTS The mean age at revision was 66 ± 5 years (male = 759, female = 1123). The male-female ratio in North American and Europeans studies was 43:57 and 34:66, respectively. The most common etiology for primary surgery in both regions was osteoarthritis or glenoid arthrosis (38%). The most common revision indication overall was rotator cuff tear, deficiency, or arthropathy (26%). The most common implant type used in revisions was a reverse shoulder arthroplasty (54%). The complication rate for all revisions was 17%. There were a total of 465 complications, and of those, 74% lead to a reoperation. CONCLUSION Generally, shoulder arthroplasties are designed to last 10-15 years; however, revisions are being performed at a mean 3.9 years from the primary procedure, based on the published studies included in this systematic review. Additionally, of the complications, a large number (74%) went on to a reoperation. Further insight into the reasons for early revisions and standardized reporting metrics and data collection on revisions is needed.
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Affiliation(s)
- Nikolas K Knowles
- Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, London, ON, Canada
| | - Melanie P Columbus
- Division of Emergency Medicine, Department of Medicine, The University of Western Ontario, London, ON, Canada
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany
| | - Louis M Ferreira
- Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, London, ON, Canada
| | - George S Athwal
- Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, London, ON, Canada.
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Politzer CS, Bala A, Seyler TM, Bolognesi MP, Garrigues GE. Use and Cost of Reverse Shoulder Arthroplasty Versus Hemiarthroplasty for Acute Proximal Humerus Fractures. Orthopedics 2020; 43:119-125. [PMID: 31930413 DOI: 10.3928/01477447-20200107-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/11/2019] [Indexed: 02/03/2023]
Abstract
Although reverse total shoulder arthroplasty (RTSA) may outperform hemiarthroplasty (HSA) for acute proximal humerus fractures (PHF), both the RTSA implant and the procedure are more expensive. The goal of this study was to compare the use and longitudinal cost of care for RTSA vs HSA for the treatment of PHF. Patients were selected from a private payer database with a surgical date between 2010 and 2015. The International Classification of Diseases, 9th Revision, Clinical Modification(ICD-9-CM), codes were used to identify patients who underwent RTSA and HSA for PHF. The 1-year cost follow-up was guaranteed. During the study period, a total of 1038 patients underwent RTSA and 1046 patients underwent HSA for the treatment of PHF. A total of 601 patients who underwent RTSA and 431 patients who underwent HSA with at least 1 year of follow-up were matched by age and sex. The average Charlson Comorbidity Index for the RTSA and HSA groups was 4, indicating similar health status. From 2010 to 2015, the use of RTSA increased linearly (R2=0.986), whereas the use of HSA decreased linearly (R2=0.796). The average index admission cost was higher for RTSA than for HSA ($15,263 vs $14,356, respectively; mean difference [MD], $907; 95% confidence interval [CI], $58-$1760; P=.04). At 1 year postoperatively, however, no statistically significant difference was noted in cost (P=.535). The 1-year physical and occupational therapy cost per patient was higher after HSA than after RTSA (MD, $723; CI, $718-$728; P<.001), but no difference was noted in discharge disposition or 1-year revision or readmission rates. The results of this study suggest that despite the higher initial cost of RTSA, the total cost of care in the year after RTSA and HSA is similar. Therefore, RTSA should be considered in the appropriate clinical setting. [Orthopedics. 2020;43(2):119-125.].
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Gauci MO, Cavalier M, Gonzalez JF, Holzer N, Baring T, Walch G, Boileau P. Revision of failed shoulder arthroplasty: epidemiology, etiology, and surgical options. J Shoulder Elbow Surg 2020; 29:541-549. [PMID: 31594726 DOI: 10.1016/j.jse.2019.07.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our aim was to analyze the epidemiology, etiologies, and revision options for failed shoulder arthroplasty from 2 tertiary centers. METHODS From 1993 to 2013, 542 failed arthroplasties were revised in 540 patients (65% women): 224 hemiarthroplasties (HAs, 41%), 237 anatomic total shoulder arthroplasties (TSAs, 44%) and 81 reverse total arthroplasties (RSAs, 15%). Data about patients, pathology, and reintervention procedures, as well as intraoperative data, were analyzed from our 2 local registries that prospectively captured all the revision procedures. Patients had an average follow-up period of 8.7 years. RESULTS The revision rate was 12.7% for HAs, 6.7% for TSAs, and 3.9% for RSAs. HAs were revised earlier (33 ± 40 months) than RSAs (47 ± 150 months) and TSAs (69 ± 61 months). Glenoid failure was a major cause of reintervention: erosion in HAs (29%) or loosening in TSAs (37%) and RSAs (24%). Instability was another major cause of reintervention: 32% in RSAs, 20% in TSAs, and 13% in HAs. Humeral implant loosening led to revision in 10% of RSAs, 6% of HAs, and 6% of TSAs. Multiple reinterventions were required in 21% of patients, mainly for instability (26%) and/or infection (25%). The final implant was an RSA in 48%, especially when associated with cuff insufficiency, instability, and/or bone loss. Final reimplantation was possible in 90% of cases, with the remaining 10% treated with a resection or spacer. CONCLUSION Glenoid failure and instability are the most common causes of revision. Soft-tissue insufficiency and/or infection results in multiple revisions. Surgeons must recognize all complications so that they can be addressed at the first revision operation and avoid further reinterventions. RSA was the most common final revision implant.
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Affiliation(s)
- Marc-Olivier Gauci
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Maxime Cavalier
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | - Jean-François Gonzalez
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France
| | | | - Toby Baring
- Homerton University Hospital Foundation Trust, London, UK
| | - Gilles Walch
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Pascal Boileau
- IULS (Institut Universitaire Locomoteur et du Sport), Hôpital Pasteur 2, Université Côte d'Azur, Nice, France.
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Garrigues GE, Zmistowski B, Cooper AM, Green A. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: management of periprosthetic shoulder infection. J Shoulder Elbow Surg 2019; 28:S67-S99. [PMID: 31196516 DOI: 10.1016/j.jse.2019.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 04/20/2019] [Indexed: 02/05/2023]
Abstract
The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. A multidisciplinary team of international experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology was assembled to form the International Consensus Group. The following consensus proceedings from the International Consensus Meeting involve 30 questions pertaining to the management of periprosthetic shoulder infection.
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Affiliation(s)
- Grant E Garrigues
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
| | - Benjamin Zmistowski
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexus M Cooper
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Green
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Lädermann A, Schwitzguebel AJ, Edwards TB, Godeneche A, Favard L, Walch G, Sirveaux F, Boileau P, Gerber C. Glenoid loosening and migration in reverse shoulder arthroplasty. Bone Joint J 2019; 101-B:461-469. [DOI: 10.1302/0301-620x.101b4.bjj-2018-1275.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. Patients and Methods We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. Results From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). Conclusion When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461–469.
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Affiliation(s)
- A. Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - A. J. Schwitzguebel
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - T. B. Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas, USA
| | - A. Godeneche
- Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital, Lyon, France
| | - L. Favard
- Service Orthopédie Traumatologie, CHU Trousseau, Tours, France
| | - G. Walch
- Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital, Lyon, France
| | - F. Sirveaux
- Division of Orthopaedics and Trauma Surgery, Centre Chirurgical Émile-Gallé, Nancy, France
| | - P. Boileau
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L’Archet–University of Nice Sophia-Antipolis, Nice, France
| | - C. Gerber
- Department of Orthopaedics, University Hospital, Balgrist, Zurich, Switzerland
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Kim K, Elbuluk A, Jia N, Osmani F, Levieddin J, Zuckerman J, Virk M. Revision shoulder arthroplasty: Patient-reported outcomes vary according to the etiology of revision. J Orthop 2018; 15:922-926. [PMID: 30190633 DOI: 10.1016/j.jor.2018.08.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/16/2018] [Indexed: 02/05/2023] Open
Abstract
Background The study evaluates patient-reported outcomes in revision shoulder arthroplasty (RevSA) according to etiology. Methods Twenty-three consecutive RevSA (minimum 2-year follow-up) were retrospectively reviewed. Patient-reported outcome (PRO) scores and range of motion were compared by the type of revision procedure and indication. Results EQ5D-QOL, VAS-pain, ASES, and forward elevation improved after RevSA. The infection group had least improvements. Revision to a reverse total shoulder arthroplasty (RTSA) demonstrated the most improvement in VAS-pain, forward elevation, and ASES. Conclusions Revision to RTSA significantly improved PRO scores compared to hemi- or total shoulder arthroplasty. RevSA for infection demonstrated the least improvement in outcomes.
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Affiliation(s)
- Kelvin Kim
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, United States
| | - Ameer Elbuluk
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, United States
| | - Nathan Jia
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, United States
| | - Feroz Osmani
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, United States
| | - Joseph Levieddin
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, United States
| | - Joseph Zuckerman
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, United States
| | - Mandeep Virk
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, United States
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Hernandez NM, Chalmers BP, Wagner ER, Sperling JW, Cofield RH, Sanchez-Sotelo J. Revision to Reverse Total Shoulder Arthroplasty Restores Stability for Patients With Unstable Shoulder Prostheses. Clin Orthop Relat Res 2017; 475:2716-2722. [PMID: 28849539 PMCID: PMC5638732 DOI: 10.1007/s11999-017-5429-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/21/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Instability after shoulder arthroplasty remains a complication with limited salvage options. Reoperation for instability with anatomic designs has led to high rates of persistent instability, therefore we aimed to evaluate the use of RSA for treatment of prosthetic instability. QUESTIONS/PURPOSES (1) After revision shoulder arthroplasty to a reverse prosthesis (RSA), what is the survivorship free from dislocations at 2 and 5 years? (2) What factors are associated with dislocations? (3) What is the survivorship free from revision after revision to RSA? (4) From preoperation to postrevision to RSA, what are the clinical outcomes-the proportion of patients with moderate to severe pain, shoulder elevation and external rotation ROM, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores? METHODS All shoulder arthroplasties revised for prosthetic instability using RSA components between January 2004 and July 2014 were retrospectively studied. During the period in question, we performed 82 revisions for instability of an anatomic total shoulder arthroplasty (TSA) (n = 62), hemiarthroplasty (n = 13), or reverse TSA (n = 7). We typically used a reverse TSA to treat this problem, but we identified 12 treated in other ways, including revision of a TSA to hemiarthroplasty (n = 3), revision of a reverse TSA to hemiarthroplasty (n = 2), revision of hemiarthroplasty to a hemiarthroplasty (n = 1), and revision of an anatomic TSA to another anatomic TSA (n = 6). This left 70 patients for evaluation; of those, 65 (93%) were available for analysis at a mean of 3 years (range, 2-10 years). A total of seven patients died. Eight of the 65 shoulders were not evaluated during the last 5 years, including three in patients who died earlier. The mean age of the patients at the time of revision RSA was 65 years (range, 40-89 years). Data were obtained from a longitudinally maintained institutional joint registry. Instability was defined as severe subluxation confirmed on clinical and radiographic examinations. We evaluated pain and ROM, and Kaplan-Meier curves were used to estimate survivorship. RESULTS The survivorship free from dislocation at 2 and 5 years was 87% (95% CI, 80%-94%) and 79% (95% CI, 67%-91%) respectively, with 10 of 65 (15%) patients having an episode of dislocation after revision surgery. Persistent instability was more common in those with a BMI greater than 35 kg/m2 (hazard ratio [HR], 5; 95% CI, 2-16; p = 0.008) and prior hemiarthroplasty (HR, 5; 95% CI, 2-16; p = 0.005), whereas patients who had undergone a previous TSA were less likely to have persistent instability (HR, 0.08; 95% CI, 0.0-0.30; p < 0.001) The survival free from rerevision for any indication at 2 and 5 years was 85% (95% CI, 76%-94%) and 78% (95% CI, 66%-90%) respectively; with the numbers available, we were not able to find associated factors. Fewer patients had moderate or severe pain after revision to RSA (preoperative: 48 of 65 [74%]; postoperative: nine of 65 [14%]; p < 0.001). After surgery, patients showed improvement in shoulder elevation (preoperative: 42° [± 30°], postoperative: 112° [42°]; mean difference, 70° [95% CI, - 83o to 57°]; p < 0.001) and external rotation (preoperative: 20° [± 22°], postoperative: 42° [± 23°]; mean difference, 22° [95% CI, - 30° to - 14°]; p < 0.001). American Shoulder and Elbow Surgeons scores improved (preoperative: 21 [± 10], postoperative: 68 [± 14], mean difference, 46 [95% CI, - 58 to - 35]; p < 0.001); where a higher score is better. Simple Shoulder Test scores also improved (preoperative: 2/12 [± 2], postoperative: 7/12 [± 3]; mean difference, 5 [95% CI, - 7 to - 2.17]; p < 0.001); where a higher score is better. CONCLUSIONS Revision RSA for prosthetic instability after shoulder arthroplasty is associated with reasonable implant survival and few complications. Approximately one in seven patients will have a recurrent dislocation. In patients with persistent instability or with risk factors for instability, consideration should be given for use of larger glenospheres and increasing the lateral offset at the time of RSA. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Nicholas M. Hernandez
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Brian P. Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Eric R. Wagner
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Robert H. Cofield
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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Kilian CM, Edwards TB. Reverse hemiarthroplasty? What happens when a patient forgoes the second stage of a 2-stage glenoid bone graft reconstruction in revision shoulder arthroplasty: a report of 3 cases. JSES OPEN ACCESS 2017; 1:79-84. [PMID: 30675544 PMCID: PMC6340856 DOI: 10.1016/j.jses.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Christopher M. Kilian
- Corresponding author: Christopher M. Kilian, MD, Fondren Orthopedic Group, Texas Orthopedic Hospital, 7401 S Main St., Houston, TX 77030, USA. (C.M. Kilian).
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Revision of reversed shoulder arthroplasty: Is a reoperation possible? OBERE EXTREMITAT 2017; 12:16-24. [PMID: 28868085 PMCID: PMC5576365 DOI: 10.1007/s11678-017-0400-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 12/16/2016] [Indexed: 10/30/2022]
Abstract
INTRODUCTION As the number of reversed shoulder arthroplasty (RSA) procedures increases, the revision rate will also increase. In case of severe bone insufficiency, instability or infection of the primary RSA, revision to another RSA is preferable but not always possible. Hemiarthroplasty (HA), spacers and resection arthroplasty (RA) have been described in this indication. MATERIALS AND METHODS Between 2004 and 2016, 20 shoulders in 19 patients were treated at Ghent University Hospital for failed revision of RSA. Nine received a megahead prosthesis, a spacer was implanted in 6, and 5 underwent RA. RESULTS Indications for implantation of a megahead prosthesis were loosening RSA (n = 5), infection (n = 4), dislocation (n = 1) and nerve irritation (n = 1). Improvement of range of motion was observed. Anterosuperior migration of the prosthesis was noted in 2 patients. Another 2 patients were ultimately revised to RSA. Seven permanent spacers were implanted for infection, of which 2 remain in place till today. The other 5 were revised to RSA. Of the 5 patients treated with RA, 3 were revised further on to RSA, resulting in pain relief and regain of function. DISCUSSION Our study shows that a megahead prosthesis has better functional results than RA, but is inferior to RSA. Due to increasing surgical experience and improving technique, 9 patients could ultimately be reconverted to another RSA. A review of current literature is presented. In HA and RA, the functional results are poor, and pain relief is uncertain. Results of spacers are variable and can be satisfactory. Arthrodesis is a last resort. CONCLUSION In our case series study, a hemiarthroplasty can be performed in case of failure of RSA. However, the results are inferior to another RSA.
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Kircher J. [Shoulder endoprosthesis in the elderly : Hemiarthroplasty or total shoulder arthroplasty? Anatomic or reverse?]. DER ORTHOPADE 2016; 46:40-47. [PMID: 27921129 DOI: 10.1007/s00132-016-3365-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Implantation of reverse shoulder endoprostheses is becoming more popular for elderly patients besides the well-established standard anatomic endoprostheses. The reasons for this are the increased life expectancy, age-dependent degeneration of the rotator cuff leading to cuff tear arthropathy, posttraumatic disability after failed osteosynthesis and primary reverse fracture arthroplasty. Stemless implants are more frequently used for primary osteoarthritis with the bone quality being the limiting factor. Modern implant systems allow the stepwise extension from bone preserving primary implants to modular and convertible revision implants that allow a partial exchange of components. Revision surgery, especially that of reverse arthroplasty, has limited potential for secondary treatment options and therefore implantation and revision should be performed in specialized treatment facilities.
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Affiliation(s)
- J Kircher
- Schulter- und Ellenbogenchirurgie, Klinik Fleetinsel Hamburg, Admiralitätstr. 3-4, 20459, Hamburg, Deutschland.
- Orthopädische Klinik, Universitätsklinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40255, Düsseldorf, Deutschland.
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