Monday, December 31, 2012

Uncemented reverse total shoulder

Radiographic results of fully uncemented trabecular metal reverse shoulder system at 1 and 2 years’ follow-up

This is radiographic followup of 98 patients undergoing uncemented reverse total shoulders. 48 had rotator cuff arthropathy, 24 had massive rotator cuff tear, 7 had rheumatoid arthritis with rotator cuff tear, 7 had failed hemiarthroplasty due to rotator cuff arthropathy, 4 had failed hemiarthroplasty due to fracture, 3 had osteoarthritis with rotator cuff tear, 3 had failed TSA due to rotator cuff tear, and 3 had failed proximal humerus open reduction– internal fixation. 

Of the 98 shoulders with followup of one year, 6% of the stems had lucent lines - these were less than 2mm. 21% of these shoulders had type 1 scapular notching, and 2% had type 2 notching. 

Of the 40 shoulders with followup of 2 years, 10% of humeral stem components had lucent lines - these were less than 2 mm. 34.2% of the scapulae had type 1 notching, 5.3% had type 2 notching, and 2.6% had type 3 notching. No stems had lucency in more than 1 zone or lucency ≥ 2 mm; 9.2% had subsidence of 2 mm or less. No glenoid components had any lucency around the baseplate or screws.

None of the patients were know to have required revision or any additional surgeries during the follow-up period.

While clinical out comes for these patients are not presented, these radiographic results are encouraging. As we pointed out in a previous post, obtaining stability of the humeral component is a greater challenge in reverse than in anatomic shoulder arthroplasty. In this series a press fit technique was used for humeral fixation. In using this method, the surgeon must be careful to avoid fracture while attempting to achieve secure fixation, especially in light of the frail bone often encountered in the older patients requiring reverse total shoulder arthroplasty.


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