Sunday, October 13, 2013

Reverse total shoulder revision of failed humeral head replacement

Increased-offset reverse shoulder arthroplasty for the treatment of failed post-traumatic humeral head replacement 

These authors reported the results with a Bayley-Walker reverse shoulder arthroplasty in 33 patients with failed post-traumatic humeral head replacement due to rotator-cuff insufficiency and glenoid erosion, but with sufficient glenoid bone stock to permit initial fixation of this prosthesis. Followup averaged 31 months. Seven patients (21%) had postrevision complications. Early dislocation occurred in 1 patient a week after surgery. Two patients had revision for aseptic loosening of the cemented humeral stem (1 patient at 13 months and the other at 27 months). Two patients sustained a periprosthetic fracture at the tip of the stem due to a fall at 1 month and 24 months after surgery.Two patients developed severe shoulder stiffness and underwent surgical release at 24 months and 40 months after surgery. Radiolucent lines around the glenoid screw were found in 6 patients (18.2%).  All the prosthesis-related complications (5 of 7 complications) occurred in patients who had more than 1 prerevision operation (ie, the original humeral head replacement was performed after previous internal fixation failed).

This prosthesis is different than those commonly used in the U.S. with a single screw glenoid fixation. Nevertheless, the results are consistent with prior reports showing the high short-term complication rate when reverse total shoulder arthroplasty is performed for failed prior arthroplasty. Component loosening, instability and periprosthetic fracture remain the most common complications. The occurrence of stiffness after a reverse total shoulder seems unusual.

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