Gallo, J Shoulder Elbow Surg 2011 - Instability after Reverse Total Shoulder Replacement

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Instability after Reverse Total Shoulder Replacement

Gallo, Warren, et al.·J Shoulder Elbow Surg·2011·152 citations·Case series

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Background

Despite advances in technique and implant design, instability after reverse total shoulder arthroplasty remains a challenging postoperative complication.

Methods

We examined our institutions' first 57 reverse total shoulder arthroplasties performed during a 3-year period (2004-2006). There were 9 cases of instability, all occurring within the first 6 months after surgery.

Results

All 9 patients had compromise of the subscapularis tendon at the time of initial reverse total shoulder implantation.
With regard to implant positioning, 2 patients had superiorly inclined metaglenes and 3 had metaglenes positioned superior to the inferior glenoid.
Each patient with a dislocation had at least 1 revision surgery, and 4 patients had underlying infection.
At most recent follow-up, only 3 patients had a concentrically reduced reverse total shoulder arthroplasty in place whereas 3 remained explanted, 2 chronically dislocated, and 1 chronically subluxated.

Conclusions

Early instability after reverse total shoulder arthroplasty can be related to inadequate soft tissue, inadequate deltoid tension, malpositioned implants, and/or infection, and outcomes of treatment of early instability are generally poor.

Level of evidence: Level IV, Case Series, Treatment Study. Copyright remains with the authors and publisher.

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Instability after Reverse Total Shoulder Replacement

Gallo, Warren, et al.·J Shoulder Elbow Surg·2011·152 citations·Case series

|

Background

Despite advances in technique and implant design, instability after reverse total shoulder arthroplasty remains a challenging postoperative complication.

Methods

We examined our institutions' first 57 reverse total shoulder arthroplasties performed during a 3-year period (2004-2006). There were 9 cases of instability, all occurring within the first 6 months after surgery.

Results

All 9 patients had compromise of the subscapularis tendon at the time of initial reverse total shoulder implantation.
With regard to implant positioning, 2 patients had superiorly inclined metaglenes and 3 had metaglenes positioned superior to the inferior glenoid.
Each patient with a dislocation had at least 1 revision surgery, and 4 patients had underlying infection.
At most recent follow-up, only 3 patients had a concentrically reduced reverse total shoulder arthroplasty in place whereas 3 remained explanted, 2 chronically dislocated, and 1 chronically subluxated.

Conclusions

Early instability after reverse total shoulder arthroplasty can be related to inadequate soft tissue, inadequate deltoid tension, malpositioned implants, and/or infection, and outcomes of treatment of early instability are generally poor.

Level of evidence: Level IV, Case Series, Treatment Study. Copyright remains with the authors and publisher.

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