Sunday, March 3, 2013

Stemless reverse total shoulder

Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening

This is a case series authored by a surgeon receiving royalties and consultant payments from the company making the stemless reverse used in this series. Fifty-six implants were reviewed at a mean of 58 months (38-95). During the same time interval 15 stemmed implants were used for revision and proximal humeral fracture. Patient age averaged 74 years. 59% had cuff tear arthropathy and 36% had massive cuff tears.

 There was substantial improvement in the Constant-Murley and Oxford Shoulder scores and an improvement in active forward flexion. No humeral loosening was observed. The complications included a metaphyseal-diaphyseal humeral bone crack without consequence, five cases of scapular notching, a superficial infection, a hematoma requiring surgical evacuation, a ruptured subscapularis, a stress fracture of the acromion at 4 years.

Revision surgery was performed in 4 cases. Dissociation of the glenoid components occurred in three cases. Three cases were revised to stemmed reverse implants. One had a implant removal. 

The authors state that the issue of glenoid component dissociation has been addressed by the manufacturer.
This is an interesting option for primary reverse total shoulders provided the bone stock is of sufficient quality. The surgeon author for this series has achieved some impressive results with this prosthesis.


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