Sunday, April 13, 2014

Reverse total shoulder for failed hemiarthroplasty for fracture.

The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture.

While humeral hemiarthroplasty is often used to treat fractures of the proximal part of the humerus, this procedure has a high failure rate because of the development of glenoid arthritis and rotator cuff deficiency due to tuberosity failure.

These authors treated 29 such patients (twenty-five women and four men) with a mean age of sixty-nine years (range, forty-two to eighty years) with removal of a hemiarthroplasty prosthesis and revision with a reverse total shoulder alone or in combination with a proximal humeral allograft.

The average total American Shoulder and Elbow Surgeons score improved from 22.3 preoperatively to 52.1.
The average American Shoulder and Elbow Surgeons pain score improved from 12.2 to 34.4 (p < 0.001), 
The average American Shoulder and Elbow Surgeons function score improved from 10.1 to 17.7 (p = 0.058). 
The average Simple Shoulder Test score improved from 0.9 to 2.6 (p = 0.004). 
The overall complication rate was 28% (eight of twenty-nine). 
Complications occurred in three of the eight patients who had been managed with an allograft-reverse total shoulder combination. One patient fell and sustained a periprosthetic humeral fracture distal to the humeral stem along with a fractured polyethylene socket at twenty months and later sustained a dislocation at twenty-five months requiring surgical revision. The second patient developed a postoperative infection that required surgical revision.  The third patient had a postoperative dislocation treated non operatively. 
Complications occurred in five of the twenty-one patients treated with a reverse total shoulder alone. One patient had failure of the baseplate with broken screws requiring surgical revision. A second patient had dislocation of the prosthesis at eight months requiring surgical revision.  A third patient had  humeral stem loosening at twenty-two months requiring surgical revision. A fourth patient underwent revision complicated by penetration of the cortex and a radial nerve palsy. The fifth patient had two dislocations and was successfully managed with closed reduction.

Comment: These results indicate the risk and complexity of revision reverse total shoulders, even in the hands of very experienced surgeons.

The treatment of substantial proximal humeral bone loss is a challenge in reverse total shoulder arthroplatsy. 
Furthermore, a malunited greater tuberosity and scarring of the posterior rotator cuff may block reduction and increase the risk of instability. The authors advise releasing the posterior rotator cuff from the proximal part of the humerus to enhance stability and soft-tissue balance.

In the presence of proximal humeral bone deficiency, the authors recommend consideration of a proximal humeral allograft  to add rotational and structural stability.

Consultation for those who live a distance away from Seattle.

Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.

To see other similar posts, click on the label of interest below.