Management of Failed Hemiarthroplasty With Reverse Prosthesis

Functional Outcomes and a Review of Management Options for Revision Shoulder Arthroplasty

Introduction

Increase in the number of primary shoulder arthroplasty has led to an increase in the number of revisions which presents many complex challenges and often has inferior outcomes.

Materials and Methods

Data was collected retrospectively, and patients were classified using Dines classification. Comprehensive case reviews were done to identify preoperative and intra-operative challenges. The primary outcome measure was Oxford shoulder score (OSS). The secondary measures were range of motion (ROM) and patient satisfaction (very satisfied, satisfied, not satisfied or worse).

Results

A total of 32 patients were identified with a mean age of 67.64 years and the most common cause of revision was a combination of bone and soft tissue failure (39.3%). All patients (n=8) with hemiarthroplasty had rotator cuff deficiency while patients with resurfacing had both rotator cuff failure and bony erosion. Four patients needed a proximal humeral osteotomy and six patients needed allograft reconstruction of the glenoid for bone loss. Twenty-one shoulders were revised to reverse total shoulder arthroplasty (TSA), 2 to anatomical TSA and 5 were left with cement spacer in situ. Mean duration of follow-up was 41.6 months. Mean OSS at the last follow-up was 26.88 with statistically significant improvement in ROM. There was no statistical difference in clinical outcomes (p>0.05) based on the type of primary prosthesis or cause of revision. A total of 70% patients were pain free. Patients with infection had inferior outcomes with a mean OSS of 17.

Conclusion

Management of patients with failed shoulder arthroplasty is often challenging but has good clinical outcome except in infections.

Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse shoulder arthroplasty

BACKGROUND

Reverse total shoulder arthroplasty is the accepted method of treatment for selected shoulder disorders. The purpose of this study was to compare primary reverse shoulder arthroplasty surgical techniques as well as clinical and radiographic outcomes in patients with acquired glenoid bone defects and in those with normal glenoid morphology.

METHODS

Preoperative three-dimensional computed tomography scans were performed on 216 shoulders in 211 patients undergoing primary reverse shoulder arthroplasty between 2004 and 2007. The glenoids were classified as normal or abnormal on the basis of preoperative radiographs and three-dimensional reconstructions of the scapula. One hundred and forty-three shoulders had been followed for two years. There were eighty-seven normal and fifty-six abnormal glenoids. The surgical techniques that were compared included bone-grafting and glenosphere selection. The clinical outcomes for the two groups were compared with respect to the American Shoulder and Elbow Surgeons score.

RESULTS

Surgical technique differed between the groups. All fifty-six glenoids with acquired bone defects had center screw placement along an alternative (scapular spine) centerline. A bone graft was used in twenty-two shoulders with acquired glenoid bone defects compared with none of those with normal glenoid morphology (p = 0.016). Shoulders with glenoid defects were treated with larger glenospheres (36 or 40 mm) more often than those with normal glenoids (p < 0.001). No significant difference was detected between the groups with regard to the preoperative or postoperative American Shoulder and Elbow Surgeons scores. Radiographs did not demonstrate failure or resorption of a glenoid bone graft when present. All outcomes improved significantly postoperatively. There were five complications, and one patient was unsatisfied with the result.

CONCLUSIONS

Glenoid bone defects, when managed with an alteration of surgical technique, including bone-grafting when indicated, are not a contraindication to reverse total shoulder arthroplasty.