Conversion to Reverse Total Shoulder Arthroplasty With and Without Humeral Stem Retention

2021 ◽  
Author(s):  
Marios Loucas ◽  
Rafael Loucas ◽  
Philipp Kriechling ◽  
Samy Bouaicha ◽  
Karl Wieser
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Stem Retention ◽  
Reverse Total Shoulder

scholarly journals Conversion to Reverse Total Shoulder Arthroplasty with and without Humeral Stem Retention: Mid-to Long-Term Results

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Marios Loucas ◽  
Rafael Loucas ◽  
Philipp Kriechling ◽  
Samy Bouaicha ◽  
Karl Wieser
Keyword(s):  
Shoulder Arthroplasty ◽  
Revision Rate ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Long Term Results ◽  
Surgical Time ◽  
Stem Revision ◽  
Stem Retention ◽  
Reverse Total Shoulder

Background: Over the past decade, conversion to Reverse Total Shoulder Arthroplasty (RTSA) has become the preferred treatment for revision of an Anatomic Hemi (HA) or Total Shoulder Arthroplasty (TSA). However, conversion of failed stemmed shoulder arthroplasty to RTSA is still a highly demanding procedure and carries unique technical challenges and risks. Questions/Purposes: This study aimed to analyze the mid- to long-term results after conversion of failed anatomical shoulder arthroplasty to RTSA and investigate whether preserving the humeral stem offers advantages over revising the humeral stem. Materials and Methods: Between 2005 and 2018, 99 hemiarthroplasties and 62 total shoulder arthroplasties (total =161 shoulders; 157 patients) were revised to RTSA without (n=47) or with (n=114) stem exchange. Complications and revisions were documented from medical and surgical records. Longitudinal pre- and post-operative clinical (Constant-Murley (CS) score, Subjective Shoulder Value (SSV)), and radiographic outcomes were assessed. Complete clinical and radiographic follow-up was available on 80% of shoulders (127 patients; 128 of 161 procedures, 46 without and 82 with stem exchange) at a minimum of 24 months and a mean of 70 months (range, 24 to 184 months). Results: Humeral stem retention was associated with a significantly reduced surgical time (193 min vs. 227 min, p=0.001, less blood loss (591 mL vs. 753 mL, p=0.037), less intraoperative complications (13% vs. 19%; Odds Ratio (OR), 1.4, p=0.32) and fewer subsequent reinterventions (19% vs. 28%; OR, 2.3, p=0.06). The complication/revision rate leading to drop out from the study was considerable in the stem revision group (ten patients; ten of 114 shoulders (9%)), but there were no complication-related dropouts in the stem-retaining group. Conclusion: Our findings suggest that humeral stem revision is associated with decreased surgical time, less blood loss, less intra- and postoperative complications, and a lower revision rate compared to humeral stem retention. Based on these findings, a shoulder arthroplasty system modularity offers substantial benefit if conversion to reverse total shoulder arthroplasty becomes necessary. Level of Evidence: Level III, therapeutic study.

Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review

2021 ◽  
pp. 175857322110193
Author(s):  
Arjun K Reddy ◽  
Jake X Checketts ◽  
B Joshua Stephens ◽  
J Michael Anderson ◽  
Craig M Cooper ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Arthroplasty ◽  
Revisional Surgery ◽  
Total Shoulder Arthroplasty ◽  
Surgical Site Infections ◽  
Total Sample ◽  
Reverse Total Shoulder Arthroplasty ◽  
Common Complication ◽  
Humeral Component ◽  
Reverse Total Shoulder

Background Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

Assessment of glenoid baseplate initial micromotion and fixation strength in reverse total shoulder arthroplasty designs using a direct shear force methodology

2021 ◽  
pp. 175857322110329
Author(s):  
Therese E Parr ◽  
Jennifer K Anderson ◽  
Alan M. Marionneaux ◽  
John M Tokish ◽  
Stefan J Tolan ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Shear Force ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Fixation Strength ◽  
Shoulder Prosthesis ◽  
Direct Shear ◽  
Device Failure ◽  
Glenoid Baseplate ◽  
Reverse Total Shoulder

Background In a reverse total shoulder arthroplasty, the altered glenohumeral joint center of rotation subjects the glenoid baseplate to increased shear forces and potential loosening. Methods This study examined glenoid baseplate micromotion and initial fixation strength with the application of direct shear force in a Sawbone model. The reverse total shoulder arthroplasty systems examined were the DJO Reverse® Shoulder Prosthesis, the Exactech Equinoxe® Reverse System, and the Tornier AequalisTM Reverse Shoulder Prosthesis. Specimens were cyclically tested with increasing shear loads until 150 µm of displacement between the implant and glenoid was achieved, and subsequently until failure, classified as either 1 cm of implant/glenoid displacement or fracture. Results The average load withstood for the 150 µm threshold for DJO, Tornier, and Exactech was 460 ± 88 N, 525 ± 100 N, and 585 ± 160 N, respectively. The average total load at device failure for DJO, Tornier, and Exactech was 980 ± 260 N, 1260 ± 120 N, and 1350 ± 230 N, respectively. Discussion The Exactech implant design trended toward requiring more load to induce micromotion at each threshold and to induce device failure, most commonly seen as inferior screw pull out. This study proposes design features that may enhance fixation and suggests little risk of initial micromotion or failure during initial post-operative recovery.

Scapular and Humeral Elevation Coordination Patterns Used Before vs. After Reverse Total Shoulder Arthroplasty

2021 ◽  
pp. 110550
Author(s):  
Antonia M. Zaferiou ◽  
Christopher B. Knowlton ◽  
Suk-Hwan Jang ◽  
Bryan M. Saltzman ◽  
Nikhil N. Verma ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Coordination Patterns ◽  
Reverse Total Shoulder

The role of the subscapularis tendon in a lateralized reverse total shoulder arthroplasty: repair versus nonrepair

2019 ◽  
Vol 43 (11) ◽  
pp. 2579-2586 ◽  
Author(s):  
Edoardo Franceschetti ◽  
Edoardo Giovannetti de Sanctis ◽  
Riccardo Ranieri ◽  
Alessio Palumbo ◽  
Michele Paciotti ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Reverse Total Shoulder Arthroplasty ◽  
Subscapularis Tendon ◽  
Reverse Total Shoulder
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