Uncemented metal-back glenoid component in revision of aseptic glenoid loosening: a prospective study of 10 cases with a minimum follow-up of 2 years.

INTRODUCTION: Glenoid component loosening comprises 25 % of all complications related to total shoulder arthroplasties (TSA). This prospective study was undertaken to assess the accuracy of an uncemented metal-back glenoid component in cases of revision of aseptic glenoid loosening. MATERIALS AND METHODS: Between September 2007 and January 2010, a total of ten patients with symptomatic glenoid loosening after TSA (7 cemented and 3 non-cemented) underwent revision surgery with an uncemented metal-back glenoid component (MB). The rotator cuff was functional in all cases. The reconstruction of the glenoid was obtained using an iliac crest graft (8 patients) or synthetic bone substitute (2 patients). The non-cemented glenoid component was fixed into the glenoid native bone, thus stabilizing the graft reconstruction. A clinical and radiological checkup was performed at the long-term follow-up and compared with the preoperative values. The patients were also asked to quantify their pain and satisfaction. RESULTS: There were no intraoperative complications. In all cases, the radiological evaluation showed a good integration of the bone graft with no radiolucency or new glenoid loosening. In one patient, the revision surgery was indicated for the dissociation between MB and polyethylene. After more than 2 years of follow-up, all patients were satisfied or highly satisfied with the outcomes. The pain VAS score (0-10) decreased from 5.1 to 0.6 (p < 0.001). The simple shoulder test increased from 3.4 to 7.9 points (gain 4.5; p < 0.001). The Constant and Murley score increased from 39.4 to 71 points (gain 31.6; p < 0.001). The gain in anterior elevation was 31°, from 118° to 149° (p < 0.001). External rotation elbow to the body (ER1) increased from an average of 34° preoperatively to 47° after surgery (p < 0.001) and external rotation at 90° of abduction from 43° to 66° (p < 0.001). CONCLUSION: This study suggests that revision with a non-cemented glenoid component associated with a bone graft can solve the difficult challenge of glenoid loosening, provided that the rotator cuff is functional and the glenoid is reconstructable. LEVEL OF EVIDENCE AND STUDY TYPE: Cohort studies (prospective) without controls, Level IV.

Results of 30 reverse shoulder prostheses for revision of failed hemi- or total shoulder arthroplasty.

PURPOSE: Revision surgery for shoulder prosthesis remains a difficult task in shoulder surgery. The purpose of this retrospective study was to evaluate the clinical and radiological outcomes of a series of 30 reverse shoulder prostheses performed as revision of failed hemi- or total shoulder arthroplasty. The most relevant technical points in surgery are described, as are other surgical options; a rational strategy for the treatment of these patients is proposed. MATERIALS AND METHODS: Thirty patients (average age 69.5) were included. Mean follow-up was 36.4 months (range 24-100 months). There were 14 patients in group 1 (Delta III) and 16 in group 2 (Reverse Arrow). RESULTS: A total of 83% were satisfied (16 cases) or very satisfied (9 cases), and 17% were disappointed (5 patients). The mean Constant score increased from a mean of 25-52. The mean score for pain improved from 5 (range 0-15) to 13 (range 5-15) (p < 0.001). The mean score of strength improved from 1 (range 0-6) to 5 (range 0-10) (p < 0.001). The forward elevation changed from a mean of 55° (range 0-120) to 108° (range 40-160) (p < 0.001). There was no significant improvement of external rotation at 0° abduction (range 14°-18°) or internal rotation (range 5-4.63). There were 4 scapular notching. We could not find the influence of scapular notching on Constant Score. Complication rate was 26.6%. CONCLUSION: Reverse total shoulder arthroplasty prosthesis represents an available option in difficult cases of failed hemiarthroplasty or total shoulder arthroplasty when the rotator cuff is irreparable and the glenoid bone stock is sufficient. LEVEL OF EVIDENCE: Level 4.

Do less medialized reverse shoulder prostheses increase motion and reduce notching?

BACKGROUND: Cuff tear arthropathy is the primary indication for total reverse shoulder arthroplasty. In patients with pseudoparalytic shoulders secondary to irreparable rotator cuff tear, reverse shoulder arthroplasty allows restoration of active anterior elevation and painless shoulder. High rates of glenoid notching have also been reported. We designed a new reverse shoulder arthroplasty with a center of rotation more lateral than the Delta prosthesis to address this problem. QUESTIONS/PURPOSES: Does reduced medialization of reverse shoulder arthroplasty improve shoulder motion, decrease glenoid notching, or increase the risk of glenoid loosening? PATIENTS AND METHODS: We retrospectively reviewed 76 patients with 76 less medialized reverse shoulder prostheses implanted for pseudoparalytic shoulder with rotator cuff deficiency between October 2003 and May 2006. Shoulder motion, Constant-Murley score, and plain radiographs were analyzed. Minimum followup was 24 months (mean, 44 months; range, 24-60 months). RESULTS: The absolute Constant-Murley score increased from 24 to 59, representing an increase of 35 points. The range of active anterior elevation increased by 61°, and the improvement in pain was 10 points. The gain in external rotation with elbow at the side was 15°, while external rotation with 90° abduction increased by 30°. Followup showed no glenoid notching and no glenoid loosening with these less medialized reverse prostheses. CONCLUSIONS: Less medialization of reverse shoulder arthroplasty improves external and medial rotation, thus facilitating the activities of daily living of older patients. The absence of glenoid notching and glenoid loosening hopefully reflects longer prosthesis survival, but longer followup is necessary to confirm these preliminary observations. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Reverse shoulder arthroplasty: does reduced medialisation improve radiological and clinical results?

The purpose of this retrospective study was to assess the effect of the reduced medialisation of the Arrow reverse shoulder prosthesis on short-term clinical and radiological results. The clinical and radiological results of 47 Delta III reverse prostheses and 49 Arrow reverse prostheses were retrospectively compared at a minimum of twelve months follow-up. There was a significant increase (p < 1.10(-4)) in range of motion from the preoperative range in the two groups except for internal rotation in the Delta III group (p = 0.1). Radiological analysis on anteroposterior view in neutral position showed greater lateralisation (p < 0.001) with the Arrow prosthesis. Scapular notching was noted in 32 patients with a Delta III prosthesis, and in no instance with an Arrow prosthesis. Complication rates were 14.9% for the Delta group and 10.2% for the Arrow group. The design features of the Arrow prosthesis--reduced medialisation of the center of rotation with lateralisation of the humerus--were found to be associated with slight improvement in range of motion and absence of scapular notching.

The reverse shoulder prosthesis--surgical technique.

In this article, the surgical technique of the reverse shoulder prosthesis is described in detail. Indications for the procedure, difficulties encountered during surgery, and potential postoperative complications and their solutions are discussed.