Sunday, July 13, 2014

Stemless reverse total shoulder

The TESS reverse shoulder arthroplasty without a stem in the treatment of cuff-deficient shoulder conditions: clinical and radiographic results

The authors of this article acknowledge that they were involved in the design of this prosthesis and receive royalties and financial related to this product as well as funding from the company for the data collection for this article.
They present the results of 91 stemless reverse total shoulders in 87 patients (61 men and 26 women), with a mean age of 73 years, at a mean follow-up of 41 months (range, 24-69 months). The indications for surgery were massive cuff tear and cuff tear arthropathy (this series did not include the higher risk diagnoses of failed arthroplasty or fracture). On average these patients had a reasonable degree of function before surgery: an average of 96 degrees of flexion and an average of 89 degrees of abduction.

Clinical scores were improved after surgery. Inferior scapular notching occurred in 17 cases (19%). The notching rate was higher when the angle between the glenoid base plate and the humeral cup increased and when there was less inferior tilt of the glenoid component. There was no radiographic evidence of component loosening at a minimum of two years.

There was a low rate of complications, which the authors suggest was related to a high degree of surgeon experience and relatively benign diagnoses; one case of instability occurred as a result of inadequate soft-tissue tensioning, which was resolved with a thicker spacer and one fracture of the spine of the scapula. There were no infections or neurologic lesions.

Comment: It is of note that, in contrast to many other publications, the patients in this series were predominantly male and did not, on average, have the commonly reported indications of pseudo paralysis or instability. It is possible that some of these patients might have been managed with a CTA prosthesis - possibly allowing them a higher level of function.


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