Customized tantalum-augmented reverse shoulder arthroplasty for glenoid bone defect and excessive medialization: description of the technique.

BACKGROUND: Glenoid bone defect and excessive medialization could represent challenging issues during reverse shoulder arthroplasty, especially in the setting of revision surgery. Although a solution is offered by the Boileau's BIO-RSA technique in primary cases, only autologous iliac crest bone graft and homologous graft from bone banks are available for revision surgeries, with known disadvantages and risk of graft resorption and implant failure. MATERIALS AND METHODS: We describe in this work a new technique based on a customized porous tantalum device to be used in salvage situations, aimed at lateralization of the glenoid component of a reverse shoulder arthroplasty. Between 2014 and 2015, five patients received a customized tantalum-augmented RSA at our institution. The augments we applied are actually on the market for acetabular bone loss management: these were opportunely prepared and fixed to the metal back of the glenoid component before implantation. RESULTS: In the five cases treated, no major or minor complications have been recorded to date. Despite the short follow-up, all the implants are still in situ. All of the patients referred complete subjective satisfaction and return to their daylife activities without pain within 4 months after surgery. CONCLUSIONS: The customized tantalum-augmented RSA technique represents in our experience a useful and safe solution in managing glenoid bone loss and medialization. Adaptability to virtually every device in the market should be regarded as important point of strength of this technique.

Venous thromboembolism in patients undergoing shoulder surgery: findings from the RECOS Registry.

BACKGROUND: Limited informations are available about venous thromboembolic (VTE) complications and thromboprophylaxis use after shoulder surgery. The primary end-point of the study was to determine the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90days after shoulder surgery. Risk factors for VTE and thromboprophylaxis practices were also studied. METHODS: RECOS is a prospective multicenter registry of consecutive patients undergoing shoulder surgery recruited in nine hospitals in Italy. Cumulative rates of VTE were estimated according to the Kaplan-Meier method; a Cox regression model was used to calculate adjusted hazard ratio (HR) and 95% confidence interval (CI) for some variables that were identified as risk factors for VTE. RESULTS: From June 2009 to June 2011 1366 patients (males 54.4%; mean age 55,65±15.3years) were enrolled. The surgical procedures were: arthroscopy (71.9%), hemiarthroplasty (17.2%) total replacement (8.9%), fixation for proximal humeral fracture (2%). After 90days, the incidence of symptomatic VTE was 0.66% (95CI% 0.2-1.12). Mean age was significantly higher in patient with than in patients without VTE (67,1+/3.49years vs 55,6+/-0,42years, respectively; p=0.024). Duration of surgery>60minutes (HR:10.99; 95CI% 1.26-95.89; p=0.030) was found as independent risk factor for VTE, while cancer, medical disease, venous insufficiency and previous VTE were not. Pharmacological thromboprophylaxis was prescribed in 33.5% (n=457) of the patients, in 95.8% of whom for a duration >10days. CONCLUSIONS: The risk of symptomatic VTE in patients undergoing shoulder surgery is low. The potential need for thromboprophylaxis should be based on a case by case evaluation.