Saturday, June 22, 2013

Reverse total shoulder - revision common

Revision of reversed total shoulder arthroplasty. Indications and outcome

This is an important article in that it reports that more than one out of six (67/441) reverse total shoulders performed between 1999 and 2008 by experienced surgeons required surgical revision. Almost half of those having a revision required a second revision and almost half of those required a third and a third of those required a fourth. Thus among the initial 441 reverse total shoulders 112 revision surgeries were performed.

The most common reason for the first revision was instability resulting in subluxation or dislocation occurring at a mean of 17 months after initial reverse total shoulder (5 days to 72 months). This complication was seen in 11 of 44 shoulders with Delta-III prostheses and in 1 of 23 patients with Anatomical Reverse prostheses. A change of components of the prosthesis was necessary in seven cases. The second most common reasons for revision were hematoma and superficial wound problems occurring after a mean of 38 days. Other frequent reasons for revision were complications of the glenoid component and acromial or coracoid fractures.  Infections, deficiency in external rotation, acromio-clavicular pathologies and humeral component loosening were followed by other infrequent reasons such as wear of components, metallosis and other rare events.

These results in the hands of expert surgeons serve to remind us of the high short and intermediate term complication rate with this procedure.

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