Guery and colleagues measured medium‑term survivorship of reverse total shoulder arthroplasty and asked whether the underlying diagnosis changed it.
Multicenter series of 80 reverse prostheses in 77 patients implanted from 1992 to 1998, with at least 5 years of follow‑up.
Methods
Design
Multicenter study
Implanted 1992 to 1998
Therapeutic Level IV
Data source
Four hospitals in France
Patients
80 shoulders in 77 patients
18 patients died and 2 were lost to follow‑up
60 shoulders in 57 patients reviewed by examination or telephone
Mean age 71 at surgery (range 58 to 87)
Exposure
Grammont Delta reverse prosthesis
Arthropathy with massive rotator cuff tear (66 shoulders)
Other etiology: rheumatoid arthritis, trauma or revision (14 shoulders)
Follow-up
Minimum 5 years
Mean 69.6 months
Outcomes
Cumulative survival to prosthesis replacement
Cumulative survival to glenoid loosening
Cumulative survival to Constant score <30
Cumulative survival to Constant pain score <10
Key Findings
Survival free of prosthesis replacement was 91% overall at 120 months and was better for massive cuff tear arthropathy than for other etiologies at 9 years (95% vs 77%, p < 0.01).
Survival free of glenoid loosening was 84% overall at 120 months, and at 7 years it was 91% for cuff tear arthropathy vs 77% for other etiologies (p < 0.05).
Survival before reaching a Constant score below 30 fell from 88% at 72 months to 58% at 120 months and did not differ significantly by etiology.
Survival free of poor pain relief (Constant pain score below 10) fell from 81% at 72 months to 61% at 120 months.
Of 9 complications, 3 were infections and 3 were glenoid components that unscrewed early in the series, before a Morse taper was used.
Shoulders with rheumatoid arthritis had the highest percentage of surgical revisions, and the authors judged the prosthesis to appear contraindicated in rheumatoid arthritis.
Board pearl
The survival curves broke twice: revisions for infection or early loosening clustered in the first 3 years, and function and pain declined from about 6 years, even on the age‑adjusted Constant score.
Authors' conclusion
Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over 70 years old with low functional demands.
Guery and colleagues measured medium‑term survivorship of reverse total shoulder arthroplasty and asked whether the underlying diagnosis changed it.
Multicenter series of 80 reverse prostheses in 77 patients implanted from 1992 to 1998, with at least 5 years of follow‑up.
Methods
Design
Multicenter study
Implanted 1992 to 1998
Therapeutic Level IV
Data source
Four hospitals in France
Patients
80 shoulders in 77 patients
18 patients died and 2 were lost to follow‑up
60 shoulders in 57 patients reviewed by examination or telephone
Mean age 71 at surgery (range 58 to 87)
Exposure
Grammont Delta reverse prosthesis
Arthropathy with massive rotator cuff tear (66 shoulders)
Other etiology: rheumatoid arthritis, trauma or revision (14 shoulders)
Follow-up
Minimum 5 years
Mean 69.6 months
Outcomes
Cumulative survival to prosthesis replacement
Cumulative survival to glenoid loosening
Cumulative survival to Constant score <30
Cumulative survival to Constant pain score <10
Key Findings
Survival free of prosthesis replacement was 91% overall at 120 months and was better for massive cuff tear arthropathy than for other etiologies at 9 years (95% vs 77%, p < 0.01).
Survival free of glenoid loosening was 84% overall at 120 months, and at 7 years it was 91% for cuff tear arthropathy vs 77% for other etiologies (p < 0.05).
Survival before reaching a Constant score below 30 fell from 88% at 72 months to 58% at 120 months and did not differ significantly by etiology.
Survival free of poor pain relief (Constant pain score below 10) fell from 81% at 72 months to 61% at 120 months.
Of 9 complications, 3 were infections and 3 were glenoid components that unscrewed early in the series, before a Morse taper was used.
Shoulders with rheumatoid arthritis had the highest percentage of surgical revisions, and the authors judged the prosthesis to appear contraindicated in rheumatoid arthritis.
Board pearl
The survival curves broke twice: revisions for infection or early loosening clustered in the first 3 years, and function and pain declined from about 6 years, even on the age‑adjusted Constant score.
Authors' conclusion
Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over 70 years old with low functional demands.