Conversion of Failed Reverse Total Shoulder Arthroplasty to Hemiarthroplasty: Three Cases of Instability and Three Cases of Glenoid Loosening

Trends in outcomes following aseptic revision shoulder arthroplasty

PURPOSE

As the incidence of anatomic and reverse total shoulder arthroplasty (TSA, RSA) increases, revision procedures will also increase with a corresponding need for counseling patients regarding outcomes. We hypothesized that different revision categories would have different complication profiles depending on both the indication as well as the nature of the prior hardware.

METHODS

A retrospective review of 1773 cases performed at a single tertiary health system utilized case postings and diagnoses to identify revision shoulder arthroplasty cases. Revisions were classified based on the prior hardware present, with basic demographics and other perioperative and postoperative outcomes recorded within the limits of available follow-up.

RESULTS

166 surgical cases involving revision of prior shoulder arthroplasty metal hardware were identified with an average follow-up of 1.0 years. Immediate perioperative outcomes of revision cases were similar relative to the companion cohort of 1607 primary cases. 137 cases (83%) required no further revision surgery, while 19 cases (11%) underwent aseptic revision, and 10 cases (6%) were revised for periprosthetic infection. RSA hardware revised to another RSA had the highest repeat revision rate relative to the other revision categories (32% vs < 14%).

CONCLUSIONS

Revision of reverse shoulder arthroplasty to a repeat reverse has the highest rate of subsequent all-cause revision, and these repeat revisions often occurred for periprosthetic infection. Despite a relatively high long-term complication rate following revision shoulder arthroplasty, immediate perioperative outcomes remain similar to primary cases, providing some preliminary evidence for policymakers considering inclusion in future value-based care models.

LEVEL OF EVIDENCE

Level III Treatment Study.

Humeral stem with low filling ratio reduces stress shielding in primary reverse shoulder arthroplasty

PURPOSE

Some patients show severe humeral bone stress shielding even one year after press-fit humeral stem, which can be a risk factor for implant durability. This study compared humeral stress shielding and clinical outcomes between high and low filling ratio (HFR and LFR) stems in primary reverse shoulder arthroplasty (RSA).

METHODS

From 2015 to 2020, 104 patients who underwent RSA with a non-cemented standard-length humeral stem were examined. The humeral stems included large press-fit stems (HFR group, 53 patients) or small non-press-fit stems with autogenous cancellous bone grafting (LFR group, 51 patients). The radiologic and clinical outcomes were compared between the groups one year post-operatively.

RESULTS

One patient in the LFR group with early infectious dislocation was excluded from the 1-one year evaluation. No stress shielding was observed in 27/50 (54.0%) and 5/53 (9.4%) of patients in the LFR and HFR groups, while 3/50 (6%) and 19/53 (35.8%) patients showed high-stress shielding, respectively. However, the stem alignment change, subsidence, complications and evidence of loosening did not differ between the groups. The final range-of-motion and functional scores were significantly poorer in the LFR group than those in the HFR group, although the difference was minimal.

CONCLUSION

Even at one year follow-up, patients receiving LFR stems with autogenous bone grafting had significantly less humeral stress shielding compared to patients with HFR stem with press-fit in primary RSA, without compromising stem stability.

Failed Reverse Total Shoulder Arthroplasty: What Are Our Bailouts?

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.