Saturday, March 16, 2013

Reverse total shoulder - complications vs etiology

Short and midterm results of reverse shoulder arthroplasty according to the preoperative etiology

These authors reviewed 76 reverse shoulder arthroplasties (RSA) for cuff tear arthropathy (45 patients), fracture sequelae (10 patients) and revision arthroplasty (21 patients) with a mean follow-up period of 23 months (±14 months). 

Patients with cuff tear arthropathy (CTA) showed a higher Constant Score (CS) of 83 % compared with patients with fracture sequelae (CS 73 %) and compared with patients who had undergone RSA as a revision for failed shoulder arthroplasty (CS 69 %). 
Within the group of fracture sequelae, patients with type three sequelae according to the Boileau classification (surgical neck nonunion) had a significantly worse outcome compared with the type four fracture sequelae patients (severe tuberosity dislocation) (CS 57 vs. 87 %, p = 0.01). 

The overall complication rate was 27 % with 8 % infections and 9 % dislocations. Revision surgery was necessary in 11.5 % with removal or replacement of the implants in 8 %. Inferior scapular notching was detected in 43 % of the patients. These patients had an inferior CS (70 ± 18 %) compared with patients without scapular notching (84 ± 25 %, p = 0.015). 

The incidence of scapular notching was significantly reduced with an increasing inferior overlap of the glenosphere.
Clearly this is a high stakes operation and we will have the opportunity to see an increasing number of complications and revisions as this procedure is being performed at an increasing rate.

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