Werner, J Bone Joint Surg Am 2005 - Treatment of Painful Pseudoparesis Due to Irreparable Rotator Cuff Dysfunction with the Delta III Reverse-Ball-And-Socket Total Shoulder Prosthesis
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Treatment of Painful Pseudoparesis Due to Irreparable Rotator Cuff Dysfunction with the Delta III Reverse-Ball-And-Socket Total Shoulder Prosthesis
Werner, Gerber, et al.·J Bone Joint Surg Am·2005·979 citations·Retrospective cohort
Werner and colleagues assessed clinical and radiographic outcomes of Delta III reverse arthroplasty in shoulders with painful pseudoparesis from irreparable rotator cuff loss.
Consecutive single‑center series of 58 patients (17 primary, 41 revision procedures), mean age 68, at Balgrist, Zürich, followed a mean of 38 months.
Methods
Design
Consecutive single‑center series, Level IV
Balgrist, University of Zürich
Patients
58 consecutive patients, 15 men and 43 women, mean age 68
Painful pseudoparesis: active elevation <90° with free passive elevation
Irreparable tear: chronic pseudoparesis, acromiohumeral distance <7 mm, and Goutallier fatty infiltration above stage 2
17 primary cases of cuff tear arthropathy
41 revisions: 21 of a failed prosthesis, 20 after other shoulder surgery
Treatment
Delta III reverse total shoulder arthroplasty
Deltopectoral approach
Immediate passive and active‑assisted motion, no abduction brace
Follow-up
Minimum 24 months, mean 38 months
50 patients examined, 44 with the prosthesis still in place
Outcomes
Subjective shoulder value
Relative Constant score
Constant pain score
Active anterior elevation, abduction and external rotation
Complications and reoperations in all 58
Scapular notching graded by the Nérot system
Key Findings
Half of the 58 patients (29) had at least one complication, most often a hematoma (12), and 19 (33%) needed a total of 31 reoperations.
Six prostheses failed, 2 removed for infection and 4 converted to hemiarthroplasty, and all six were revision cases.
Revisions needed reoperation more often than primary procedures (39% vs 18%, p = 0.005), although complication rates did not differ significantly (51% vs 47%).
The final relative Constant score was higher after primary procedures than after revisions (72% vs 58%, p = 0.03).
When the prosthesis was retained, complications and reoperations did not affect subjective results or satisfaction.
Notching reached or passed the inferior screw in 21 cases (46%), but in 38 of 48 cases followed on later films the defect did not enlarge after the first year.
Board pearl
Inferior scapular neck notching appeared on 96% of the 48 interpretable follow‑up radiographs, yet it showed no correlation with any clinical result or complication.
Authors' conclusion
Total shoulder arthroplasty with the Delta III prosthesis is a salvage procedure for severe shoulder dysfunction caused by an irreparable rotator cuff tear associated with other glenohumeral lesions. Complications were frequent following both primary and revision procedures, but they rarely affected the final outcome. The procedure has a substantial potential to improve the condition of patients with severe shoulder dysfunction, at least in the short term.
Werner and colleagues assessed clinical and radiographic outcomes of Delta III reverse arthroplasty in shoulders with painful pseudoparesis from irreparable rotator cuff loss.
Consecutive single‑center series of 58 patients (17 primary, 41 revision procedures), mean age 68, at Balgrist, Zürich, followed a mean of 38 months.
Methods
Design
Consecutive single‑center series, Level IV
Balgrist, University of Zürich
Patients
58 consecutive patients, 15 men and 43 women, mean age 68
Painful pseudoparesis: active elevation <90° with free passive elevation
Irreparable tear: chronic pseudoparesis, acromiohumeral distance <7 mm, and Goutallier fatty infiltration above stage 2
17 primary cases of cuff tear arthropathy
41 revisions: 21 of a failed prosthesis, 20 after other shoulder surgery
Treatment
Delta III reverse total shoulder arthroplasty
Deltopectoral approach
Immediate passive and active‑assisted motion, no abduction brace
Follow-up
Minimum 24 months, mean 38 months
50 patients examined, 44 with the prosthesis still in place
Outcomes
Subjective shoulder value
Relative Constant score
Constant pain score
Active anterior elevation, abduction and external rotation
Complications and reoperations in all 58
Scapular notching graded by the Nérot system
Key Findings
Half of the 58 patients (29) had at least one complication, most often a hematoma (12), and 19 (33%) needed a total of 31 reoperations.
Six prostheses failed, 2 removed for infection and 4 converted to hemiarthroplasty, and all six were revision cases.
Revisions needed reoperation more often than primary procedures (39% vs 18%, p = 0.005), although complication rates did not differ significantly (51% vs 47%).
The final relative Constant score was higher after primary procedures than after revisions (72% vs 58%, p = 0.03).
When the prosthesis was retained, complications and reoperations did not affect subjective results or satisfaction.
Notching reached or passed the inferior screw in 21 cases (46%), but in 38 of 48 cases followed on later films the defect did not enlarge after the first year.
Board pearl
Inferior scapular neck notching appeared on 96% of the 48 interpretable follow‑up radiographs, yet it showed no correlation with any clinical result or complication.
Authors' conclusion
Total shoulder arthroplasty with the Delta III prosthesis is a salvage procedure for severe shoulder dysfunction caused by an irreparable rotator cuff tear associated with other glenohumeral lesions. Complications were frequent following both primary and revision procedures, but they rarely affected the final outcome. The procedure has a substantial potential to improve the condition of patients with severe shoulder dysfunction, at least in the short term.