These authors reviewed 50 cases of reverse shoulder arthroplasty used to treat sequelae of proximal humerus fractures.The patients had a mean age of 69 (range 44-89) and a mean followup of 34 months.
Shoulders with proximal humeral metaphyseal bone loss of more than 3 cm had significantly lower clinical outcomes. In addition degenerative changes of the teres minor muscle and the number if prior surgeries also had significant negative influences on clinical results.
There were five revisions (10%) for infection (3 cases), instability (1 case), and stiffness (1 case).
Comment: The best results with reverse total shoulders are obtained when the pathology is simple, for example in cases of previously unoperated rotator cuff tear arthropathy. The results are poorer when the pathology is complicated, for example in failed prior arthroplasty or in cases of post traumatic bone loss as pointed out in this paper. This information informs our discussions with patients considering reverse total shoulder and points to the need for careful stratification of preoperative pathology when outcomes of reverse total shoulder are compared.
It is of note that the most common complication was infection in this series.
One of the particular challenges in performing reverse total shoulders in the presence of proximal bone loss is fixation of the humeral component. As shown in the x-ray below, the stems of reverse total shoulder humeral components are essentially circular in cross section - thus the fixation is at risk for failure when torque is applied to the humeral component.
In such cases, securing humeral component fixation is critical to the success of the procedure.
===
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 run, reverse total shoulder, CTA 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.
