Saturday, August 8, 2015

Reverse total shoulder - what can we learn from revisions?

Elucidating trends in revision reverse total shoulder arthroplasty procedures: a retrieval study evaluating clinical, radiographic, and functional outcomes data.

These authors examined 50 RTSA implants, retrieved from 44 patients, with 50 polyethylene (PE) liners, 30 glenospheres, 21 glenoid baseplates, 13 modular humeral metaphases, and 17 humeral stems for damage modes (abrasion, burnishing, dishing, embedding, scratching, pitting, polyethylene delamination and edge deformation). 

Average term of implantation was 20 months (range, 0-81 months). Metallic components exhibited abrasion, burnishing, dishing, pitting, and scratching. PE liners displayed all damage modes. Damage was exhibited on 93% of glenospheres and 100% of PE liners. Of 29 aseptic shoulders, 13 showed evidence of scapular notching and 5 of humeral loosening. There was a moderate correlation between radiographically observed implant failure or dissociation and PE embedding. There were weak and moderate correlations between scapular notching severity and PE dishing, embedding, and delamination.

In 19 cases the revision was because of infection or suspected infection. The known organisms included Propionibacterium (4), enterococcus (1), methicillin-resistant Staphylococcus aureus (1), gram-negative bacilli (2), methicillin resistant Staphylococcus epidermidis (1), gram positive cocci (1), and yeast (1).

Comment: This series shows that reverse total shoulder implants show evidence of damage and wear at the time of retrieval. We do not yet know if this damage led to the need for revision surgery. We also do not yet know whether similar amounts of damage exist in functional reverse total shoulders that remain in situ.


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