Sunday, June 12, 2016

Failed reverse total shoulders, is conversion to a hemiarthroplasty a good solution?

Conversion to hemiarthroplasty as a salvage procedure for failed reverse shoulder arthroplasty.

These authors report on 16 patients having conversion of a failed reverse shoulder arthroplasty (RSA) to a hemiarthroplasty. All patients had insufficient bone stock for reimplantation of another RSA.

The prostheses in this series were all of the Grammont type (no glenosphere offset from the glenoid) with splayed screws that can weaken the bone at the base of the scapular spine.


The apparent indications for revision were 
aseptic glenoid loosening in 7
scapular spine fracture and glenoid loosening in 4
infection in 3 (note that one Propionibacterium infection presented 8 years after the reverse!)
periprosthetic humeral fracture in 2

Postoperative functional outcome was generally poor at the latest follow-up.
Medialization progressed beyond the coracoid in 6 patients, and complete anterosuperior escape was reported in 3 patients (see below).

Three postoperative complications were recorded by the final follow-up, including 2 periprosthetic humeral fractures treated conservatively and 1 patient with painful humeral component medialization leading to resection arthroplasty.

Comment: This article deserves our attention in that with the increasing use of reverse total shoulder arthroplasty, more and more revisions will be on the horizon. While in some cases the reverse can be salvaged, infection, loss of glenoid bone stock, loss of humeral bone stock and scapular spine fractures can preclude a successful revision.

Meticulous, bone preserving surgical technique and proper prosthesis selection may help reduce the risk of reverse arthroplasty failure.

Our technique for reverse total shoulder arthroplasty is shown in this link.