Melis, J Shoulder Elbow Surg 2012 - Glenoid Loosening and Failure in Anatomical Total Shoulder Arthroplasty: Is Revision with a Reverse Shoulder Arthroplasty a Reliable Option?
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Glenoid Loosening and Failure in Anatomical Total Shoulder Arthroplasty: Is Revision with a Reverse Shoulder Arthroplasty a Reliable Option?
Melis, Boileau, et al.·J Shoulder Elbow Surg·2012·217 citations
Melis and colleagues asked whether converting a failed anatomic TSA glenoid to a reverse prosthesis gives reliable results.
Retrospective cohort from 7 specialized shoulder centers, 1991 to 2006: 37 of 40 revisions reviewed at a minimum of 2 years (mean 47 months). Four authors report Tornier royalties.
Revision to a reverse prosthesis would reliably address the associated glenoid bone loss, cuff insufficiency and instability.
Key Findings
In the 35 patients who kept the prosthesis, mean Constant score rose from 24.3 before revision to 55.2 at last follow‑up (p < 0.0001).
Active anterior elevation improved from 68° to 121° (p < 0.0001). Internal and external rotation did not change.
Thirty‑two of 37 patients (86%) were satisfied or very satisfied. Of the 5 dissatisfied, 2 had the reverse removed and 2 had unexplained persistent pain.
The glenoid graft healed in 22 of 29 cases (76%), and 6 (21%) showed partial resorption.
Eleven patients (30%) had a postoperative complication and 8 (22%) needed reoperation: 3 for recurrent glenoid loosening, 3 for anterior instability and 2 for humeral subsidence.
Recurrent glenoid loosening was attributed mainly to a baseplate peg too short to reach native glenoid beyond the graft. Both cases re‑revised with a long peg healed without loosening.
Authors' conclusion
Revision with a RSA is a reliable therapeutic option which provides the double benefit of glenoid bone stock reconstruction by fixing the bone graft with the help of the baseplate and screws and of solving the problem of soft tissue insufficiency and prosthetic instability. However, surgeons should be aware that the rate of postoperative complications and subsequent reoperations is high, and that the surgical technique is demanding.
Melis and colleagues asked whether converting a failed anatomic TSA glenoid to a reverse prosthesis gives reliable results.
Retrospective cohort from 7 specialized shoulder centers, 1991 to 2006: 37 of 40 revisions reviewed at a minimum of 2 years (mean 47 months). Four authors report Tornier royalties.
Revision to a reverse prosthesis would reliably address the associated glenoid bone loss, cuff insufficiency and instability.
Key Findings
In the 35 patients who kept the prosthesis, mean Constant score rose from 24.3 before revision to 55.2 at last follow‑up (p < 0.0001).
Active anterior elevation improved from 68° to 121° (p < 0.0001). Internal and external rotation did not change.
Thirty‑two of 37 patients (86%) were satisfied or very satisfied. Of the 5 dissatisfied, 2 had the reverse removed and 2 had unexplained persistent pain.
The glenoid graft healed in 22 of 29 cases (76%), and 6 (21%) showed partial resorption.
Eleven patients (30%) had a postoperative complication and 8 (22%) needed reoperation: 3 for recurrent glenoid loosening, 3 for anterior instability and 2 for humeral subsidence.
Recurrent glenoid loosening was attributed mainly to a baseplate peg too short to reach native glenoid beyond the graft. Both cases re‑revised with a long peg healed without loosening.
Authors' conclusion
Revision with a RSA is a reliable therapeutic option which provides the double benefit of glenoid bone stock reconstruction by fixing the bone graft with the help of the baseplate and screws and of solving the problem of soft tissue insufficiency and prosthetic instability. However, surgeons should be aware that the rate of postoperative complications and subsequent reoperations is high, and that the surgical technique is demanding.