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Ranieri R, Anzillotti G, Rose GD, Borroni M, Garofalo R, Castagna A. Anatomical total shoulder arthroplasty revision to reverse shoulder arthroplasty using convertible glenoid: a systematic review of clinical and radiological outcomes. INTERNATIONAL ORTHOPAEDICS 2024; 48:2411-2419. [PMID: 38656616 DOI: 10.1007/s00264-024-06188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The aim of the present systematic review is to collect all the available evidence regarding the clinical and radiological results of revision to reverse shoulder arthroplasty (RSA) of modular anatomic shoulder prostheses (TSA) using a convertible metal-backed glenoid (MBG). METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies investigating revision of TSA to RSA utilizing a convertible MBG and reporting clinical and radiological outcomes were identified. RESULTS A total of five studies on the use of convertible modular glenoid component in the setting of TSA revision to RSA were finally included in the present systematic review. A total of 60 procedures were reported. Mean operative times was 65 min. Intraoperative complications included 3 cases of glenoid loosening. Only one case of dislocation was reported as postoperative complication. At mean follow-up of 32.3 months post-revision, no glenoid loosening was reported, VAS score decreased from 7.7 to 1.5, Constant Score increased from 24.8 to 57.6. CONCLUSIONS Revision to RSA after failed TSA using a convertible modular glenoid component was associated with a low rate of intraoperative and postoperative complications, low surgical time and led to good results in term of pain relieve and functional outcomes. Given the complexity and risk associated with revision of anatomic shoulder prosthesis having a convertible glenoid may help to simplify the procedure and improve clinical results.
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Affiliation(s)
- Riccardo Ranieri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20072, Milan, Italy.
| | - Giuseppe Anzillotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20072, Milan, Italy
| | - Giacomo Delle Rose
- Shoulder and Elbow Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Mario Borroni
- Shoulder and Elbow Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Raffaele Garofalo
- Shoulder and Sport Medicine Unit, Miulli Hospital, Strada Prov. 127 Acquaviva - Santeramo Km, 4, 100 Acquaviva Delle Fonti, 70021, Bari, Italy
- Shoulder and Elbow Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20072, Milan, Italy
- Shoulder and Elbow Unit, IRCCS Humanitas Research Hospital, via Manzoni 56 Rozzano, 20089, Milan, Italy
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John MP, Wilson JT, Mesa L, Simon P, Frankle MA. Revision reverse shoulder arthroplasty for the management of baseplate failure: an analysis of 676 revision reverse shoulder arthroplasty procedures. J Shoulder Elbow Surg 2024; 33:707-714. [PMID: 37543279 DOI: 10.1016/j.jse.2023.06.039] [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: 04/02/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Baseplate failure in reverse shoulder arthroplasty (RSA) is a rare but potentially catastrophic complication owing to poor patient outcomes and significant glenoid bone loss. The purpose of this study was to report on the prevalence, causes, and outcomes of revision RSA (rRSA) for baseplate failure or loosening. METHODS A retrospective review of our institutional database was performed to identify all patients treated for a failed RSA from 2006 to 2021 who required revision to another RSA (rRSA) performed by a single surgeon. A total of 676 failed RSA procedures were identified, and further analysis identified 46 patients (6.8%) who underwent rRSA for baseplate failure with a confirmed loose baseplate at the time of rRSA. The primary outcome was repeated failure of the reimplanted baseplate following rRSA. The mode of failure associated with baseplate failure was stratified into 1 of 3 groups: aseptic, septic, or traumatic. Twenty-four patients underwent primary revision, and 22 had undergone >1 previous arthroplasty prior to undergoing re-revision. Five patients underwent previous rRSA for baseplate failure performed by an outside surgeon. The criteria for secondary outcome analysis of final American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, and range of motion were met by 32 patients and 23 patients at 1- and 2-year follow-up, respectively. RESULTS Three patients (6.5%) had repeated baseplate failure requiring re-revision; 2 had baseplate failure at <1 year with associated periprosthetic infections and underwent conversion to hemiarthroplasty. The third patient experienced traumatic failure at 10 years and underwent successful rRSA. The mean American Shoulder and Elbow Surgeons scores at 1 and 2 years were 62.3 and 61.7, respectively. There was no significant difference in outcomes based on mode of baseplate failure (P = .232) or total arthroplasty burden (P = .305) at 1 year. There were 13 total complications in 11 patients, 5 of which required reoperation for reasons other than baseplate failure. CONCLUSION In this study, rRSA for baseplate failure constituted 6.8% of all revisions performed over a period of 15 years. Re-revision for recurrent baseplate failure was required in 3 of 46 patients (6.5%). Complications and reoperation rates were higher than those for primary RSA but outcomes were comparable for revision of failed anatomic shoulder arthroplasty.
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Affiliation(s)
- Mitchell P John
- Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA.
| | - John T Wilson
- Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA
| | - Lazaro Mesa
- Department of Orthopaedic Surgery, University of South Florida, Tampa, FL, USA
| | - Peter Simon
- Foundation of Orthopaedic Research and Education, Tampa, FL, USA
| | - Mark A Frankle
- Foundation of Orthopaedic Research and Education, Tampa, FL, USA; Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA
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Vegas A, Cannon D, Lewis S, Mekkawy KL, Glener J, Rodriguez HC, Schodlbauer D, Levy JC. Functional and radiographic results of anatomic total shoulder arthroplasty in the setting of subscapularis dysfunction: 5-year outcomes analysis. J Shoulder Elbow Surg 2024; 33:e79-e87. [PMID: 37473908 DOI: 10.1016/j.jse.2023.06.015] [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: 01/15/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Subscapularis management is a critical component to the success of anatomic total shoulder arthroplasty (TSA). Failure to heal the subscapularis can result in pain, weakness, loss of function, and revision. However, not all patients have poor outcomes. The purpose of this study is to compare patients with normal and dysfunctional subscapularis function following TSA in regard to (1) patient-reported outcome measures (PROMs); (2) range of motion (ROM) and strength; (3) achievement of minimal clinically important differences (MCIDs); and (4) specific functional internal rotation tasks. METHODS A retrospective review of patients treated with TSA for osteoarthritis with a minimum 2-year follow-up was performed to identify patients with subscapularis dysfunction. Subscapularis dysfunction was diagnosed when any degree of weakness in internal rotation was detected on physical examination (positive belly press sign). These patients were case controlled matched on a 1:3 ratio to patients with normal subscapularis function based on age and sex. PROMs, measured active motion, revision rates, patient satisfaction, and postoperative radiographic findings were compared. Population-specific institutional anchor-based MCID values were used to compare the improvement in PROM. RESULTS Of the 668 patients included, 34 patients (5.1%) demonstrated evidence of subscapularis dysfunction. Mean follow-up for the normal subscapularis function cohort was 63.4 ± 29.7 and 58.7 ± 26.8 for the dysfunctional subscapularis cohort. Patients with subscapularis dysfunction demonstrated significantly worse postoperative Simple Shoulder Test, Single Assessment Numerical Evaluation, visual analog scale (VAS) function, VAS pain, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores with higher rates of unsatisfactory results when compared to patients with normal subscapularis function. Abduction, elevation, internal rotation ROM, along with supraspinatus and external rotation strength were also significantly worse in the dysfunctional group. Similarly, these patients were more likely to have decreased ability to perform functional internal rotation tasks, with only 47% of the patients being able to reach the small of their back compared to 85% with normal subscapularis function. Radiographically, the dysfunctional cohort demonstrated higher rates of anterior subluxation (56% vs. 7%; P < .001) and glenoid loosening (24% vs. 5%; P = .004). Similarly, revision rates were significantly higher for patients with subscapularis dysfunction (8 patients, 23.5%). Nonetheless, the dysfunctional subscapularis cohort demonstrated improvements in VAS pain (4.0 ± 3.7) and ASES (46.4 ± 35.9) scores that exceeded MCID thresholds. CONCLUSION Patients who develop subscapularis dysfunction after TSA have significantly worse PROMs, ROM, functional tasks of internal rotation, and radiographic outcomes, as well as increased rates of revision. Although patients show worse outcomes and high revision rates compared with their normal-functioning counterparts, these patients maintained improvement above MCID thresholds for pain and function at a mean 5-year follow-up.
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Affiliation(s)
- Austin Vegas
- Department of Orthopedic Surgery, Larkin Community Hospital, South Miami, FL, USA
| | - Dylan Cannon
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Steven Lewis
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | | | - Julie Glener
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
| | - Hugo C Rodriguez
- Department of Orthopedic Surgery, Larkin Community Hospital, South Miami, FL, USA
| | - Daniel Schodlbauer
- Levy Shoulder Center at Paley Orthopedic and Spine Institute, Boca Raton, FL, USA
| | - Jonathan C Levy
- Levy Shoulder Center at Paley Orthopedic and Spine Institute, Boca Raton, FL, USA.
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Kleim BD, Zolotar A, Hinz M, Nadjar R, Siebenlist S, Brunner UH. Pyrocarbon hemiprostheses show little glenoid erosion and good clinical function at 5.5 years of follow-up. J Shoulder Elbow Surg 2024; 33:55-64. [PMID: 37385424 DOI: 10.1016/j.jse.2023.05.027] [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: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The success of traditional shoulder hemiarthroplasty (HA) with cobalt-chromium heads is limited by painful glenoid erosion with problematic bone loss. Hemiprostheses with pyrolytic carbon (PyC) heads have shown reduced glenoid erosion in experimental laboratory studies. Few in vivo data are available. METHODS We performed a single-center consecutive cohort study of 31 of 34 patients (91%) who underwent PyC HA between September 2013 and June 2018. In 11 of these patients, concentric glenoid reaming was additionally performed. The mean follow-up period was 5.5 years (range, 3.5-7 years). Standardized radiographs were taken, and clinical function (Constant score) and pain (visual analog scale score) were recorded. Anteroposterior radiographs were analyzed according to an established method by 2 independent observers: A line parallel to the superior and inferior glenoid rim was translated to the most medial point of the glenoid surface. A further parallel line was placed on the spinoglenoid notch. The distance between these 2 lines was measured. Measurements were scaled using the known diameter of the implanted humeral head component. To assess eccentric erosion, anteroposterior and axial images were classified according to Favard and Walch, respectively. RESULTS Mean medial glenoid erosion measured 1.4 mm at an average of 5.5 years of follow-up. In the first year, 0.8 mm of erosion was observed, significantly more than the average erosion per year of 0.3 mm (P < .001). Mean erosion per year was 0.4 mm in patients with glenoid reaming vs. 0.2 mm in those without reaming (P = .09). An evolution of glenoid morphology was observed in 6 patients, of whom 4 had a progression of the erosion grade. The prosthesis survival rate was 100%. The Constant score improved from 45.0 preoperatively to 78.0 at 2-3 years postoperatively and 78.8 at latest follow-up (5.5 years postoperatively) (P < .001). The pain score on a visual analog scale decreased from 6.7 (range, 3-9) preoperatively to 2.2 (range, 0-8) at latest follow-up (P < .001). There was a weak correlation (r = 0.37) between erosion and pain improvement (P = .039) and no correlation between erosion and change in Constant score (r = 0.06). CONCLUSION PyC HA caused little glenoid erosion and a sustained improvement in clinical function in our cohort at mid-term follow-up. PyC demonstrates a biphasic development of glenoid erosion, with a reduced rate after the first year. PyC HA should therefore be considered as an alternative to cobalt-chromium HA and to anatomical total shoulder arthroplasty for patients with a high risk of glenoid component complications.
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Affiliation(s)
- Benjamin D Kleim
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany; Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany.
| | - Aleksei Zolotar
- Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany
| | - Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Rudolf Nadjar
- Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Ulrich H Brunner
- Department for Trauma and Orthopaedic Surgery, Agatharied Hospital, Hausham, Germany
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O'Keefe DS, Hao KA, Teurlings TL, Wright TW, Wright JO, Schoch BS, Farmer KW, Struk AM, King JJ. Survivorship analysis of revision reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022:S1058-2746(22)00918-1. [PMID: 36584868 DOI: 10.1016/j.jse.2022.11.024] [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: 07/31/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The expansion of indications for reverse total shoulder arthroplasty (RTSA) has resulted in a rapid increase in the incidence of subsequent revision procedures. The purpose of this study was to identify the incidence and risk factors for re-revision shoulder arthroplasty after first revision RTSA. METHODS We retrospectively queried our institutional shoulder arthroplasty database of prospectively collected data from 2003 to 2019. To assess revision implant survival, patients were censored on the date of re-revision surgery or, if the revision arthroplasty was not revised, at the most recent follow-up or their date of death. Patients with a prior infection, concern for infection at the time of revision, antibiotic spacer, or oncologic indication for primary arthroplasty were excluded. A total of 186 revision RTSAs were included, with 32 undergoing re-revision shoulder arthroplasty. The Kaplan-Meier method and bivariate Cox regression were used to assess the relationship of patient and surgical characteristics on implant survivorship. Multivariate Cox regression was performed to identify independent predictors of re-revision. RESULTS Re-revision shoulder arthroplasty was most commonly performed for instability (34%), infection (28%), and glenoid loosening (19%). Overall re-revision rates at 6 months (7%), 1 year (9%), and 2 years (13%) were relatively low; however, the rate of re-revision increased at 5 years (35%). Men underwent re-revision more often than women within the first 6 months after revision RTSA (12% vs. 2%; P = .025), but not thereafter. On multivariate analysis, increased estimated blood loss was associated with a greater risk of undergoing re-revision shoulder arthroplasty (hazard ratio: 41.16 [3.34-506.50]; P = .004). CONCLUSION The rate of re-revision after revision RTSA is low in the first 2 years postoperatively (13%) but increases to 35% at 5 years. Increased estimated blood loss, which may reflect greater operative complexity, was identified as a risk factor that may confer an increased chance of re-revision after revision RTSA. Knowledge of risk factors for re-revision after revision RTSA can aid surgeons and patients in preoperative counseling.
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Affiliation(s)
- Daniel S O'Keefe
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Tyler L Teurlings
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA.
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Melvani R, Diaz MA, Wilder L, Christmas KN, Simon P, Cronin KJ, Mighell MA, Frankle MA. Improved mechanical fixation of an all-polyethylene glenoid reduces postoperative radiolucent lines. J Shoulder Elbow Surg 2022; 31:e386-e398. [PMID: 35339705 DOI: 10.1016/j.jse.2022.02.016] [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: 11/04/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rationale for advances in implant design is to improve performance in comparison to their predecessors. The purpose of this study was to compare a newer, self-pressurizing peripheral peg glenoid to a traditional polyethylene pegged glenoid through biomechanical evaluation and a retrospective radiographic and clinical review. METHODS Three testing conditions (uncemented, partially cemented, and fully cemented) were chosen to assess the 2 component designs in a foam block model. The number of hammer hits to seat the component, amount of time to seat the component, and resistance-to-seat were collected. The implants were then cyclically loaded following ASTM F2028-17 testing standard. Clinically, postoperative radiographs of patients with a self-pressurized glenoid component (n = 225 patients) and traditional glenoid component (n = 206 patients) were evaluated for radiolucent lines and glenoid seating at various timepoints. Clinical outcomes (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Simple Shoulder Test, and visual analog scale pain scores) and complications were recorded. The presence of radiolucent lines at the bone-cement interface was evaluated using the Modified Franklin Grade and the Lazarus grade. RESULTS The self-pressurizing glenoid design required significantly more hammer hits than traditional glenoid designs in all groups tested (P < .029). Moreover, the self-pressurizing design had significantly more resistance-to-seat than traditional components in both the uncemented and partially cemented group (P < .002). No difference in resistance-to-seat was found between designs in the fully cemented group. The uncemented and partially cemented groups did not survive the full 50,000 cycles; however the self-pressurizing design had significantly less motion than the traditional design (P < .001). No differences between component designs were found in the fully cemented group at 50,000 cycles. The self-pressurizing glenoid component had 0.005% radiographic radiolucent lines, and the traditional glenoid component had 45% radiographic radiolucent lines, with 38% of the radiolucencies in the traditional glenoid component group being defined as grade E. There were no progressive radiolucencies, differences in clinical outcomes, or complications at 2 years postoperatively. CONCLUSION In the fully cemented condition, the 2 component designs had comparable performance; however, the differences in designs could be better observed in the uncemented group. The self-pressurizing all-polyethylene design studied has superior biomechanical stability. Clinically, the improved stability of the glenoid component correlated with a reduction of radiolucent lines and will likely lead to a reduction in glenoid component loosening.
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Affiliation(s)
| | - Miguel A Diaz
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Lauren Wilder
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | | | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA; Department of Medical Engineering, University of South Florida, Tampa, FL, USA
| | - Kevin J Cronin
- Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Mighell
- Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Frankle
- Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, 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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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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