Monday, September 22, 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.

These authors, including the co-conceptor of the design, enrolled 101 patients having 105 stemless reverse total shoulders in a prospective study, with a minimum follow-up period of 24 months. 91 procedures in 87 patients (61 men and 26 women), with a mean age of 73 years, were available at a mean follow-up of 41 months (range, 24-69 months).

Ninety-six percent of patients rated their satisfaction as good or excellent. Mean flexion was 143° (range, 90°-170°), and mean external rotation was 39° (range, 20°-70°). The Constant score improved from 40 points preoperatively to 68 points at last follow-up (P < .001). The mean American Shoulder and Elbow Surgeons score was 24 points. The mean neck-shaft angle was 154° (range, 142°-165°). Inferior scapular notching occurred in 17 cases (19%). The notching rate was higher when the glenometaphyseal angle increased (P < .001), when the inferior tilt decreased (P = .003), and when the neck-shaft angle increased. The authors reported no evidence of component loosening.

Comment: These patients had the diagnosis of either cuff tear arthropathy or failed cuff repair - patients with the important diagnoses of failed anatomic arthroplasty or fracture were not included, probably because this prosthesis is not suitable in these situations.

The preoperative flexion averaged 96 degrees and abduction averaged 89 degrees with some patients having as much as 160 degrees of preoperative elevation. Thus all these patients did not have the classic indications for a reverse (pseudoparalysis or anterosuperior escape).

The results point out the variability in the position in which the components can be inserted.