Wednesday, December 17, 2014

Reverse total shoulder results / complications

Reverse shoulder arthroplasty in 41 patients with cuff tear arthropathy with a mean follow-up period of 5 years.

These authors report on 41 Delta III reverse total shoulder arthroplasties were performed by an anterosuperior (McKenzie) approach in 37 patients (29 women and 8 men) with pseudoparalysis due to cuff tear arthropathy. The patients' mean age was 79 years (range, 68-91 years). The mean follow-up period was 5 years.

The Constant and Oxford scores were improved as were the mean abduction and forward flexion (64° to 100°) and (55° to 110°). Scapular notching was seen in 68% of patients, but there was no apparent deterioration in function or satisfaction scores. Stress shielding of the proximal humerus was seen in 10% of patients.

The complications included one case of glenoid failure from a fall at 6 weeks after surgery, another case of glenoid loosening after a fall, a fractured acromion after a fall, and a fractured glenoid screw with persistent shoulder pain.

Comment:  This report is of interest in that the McKenzie approach (through the raphe between the anterior and middle deltoid) was used - currently a less common approach than the anterior deltopectoral approach. It also reveals that patients having reverse total shoulders tend to fall and that falls can challenge the fixation of the glenoid into often soft bone. If falls occur early after surgery they can be a particular problem if glenoid fixation depends on bone ingrowth. Finally, it is of note that these patients were older than those in many other series of reverse total shoulders.


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