Sunday, July 26, 2015

Reverse total shoulder arthroplasty - failure and revision - cautionary tale!

Failure after reverse total shoulder arthroplasty: what is the success of component revision?

These authors performed 228 reverse total shoulders over the study periord. 17 had revision surgery - one passed away. They were able to review 16 of these patients having component revision after failure of a prior reverse total shoulder arthroplasty (RTSA). Their overall rate of reoperation was 10% with 7.5% needing component revision. Nine patients had complications of their revision RTSA (persistent instability, failure of baseplate, infection, screw impingement, periprosthetic humeral fracture and glenoid fracture).

Original components for the index RTSA included the Zimmer Anatomical Reverse in 10, Tornier Aequalis in 4  and DePuy Delta III in 2 shoulders.

Seven had failure of the baseplate - three of these revisions failed.

Six had instability - three of these revisions failed.

Two had infection - both required multiple procedures

One had humeral component loosening - the functional results and radiographic results were 'less than ideal'

While overall the patients were improved, nine patients suffered major complications 6 ultimately underwent further procedures.

Comment: In the hands of these expert surgeons, the overall revision rate was 8%. Baseplate failure, instability and infection were the major issues.


We have attempted to minimize the risk of these complications by assuring excellent purchase of the baseplate by strong glenoid fixation screws and by East-West tensioning of the soft tissues as described in this link and here.


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