Thursday, November 3, 2016

Reverse total shoulder - is a short stem better?

Reverse shoulder arthroplasty with a cement less short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study

These authors present the clinical and radiologic outcomes at 2 to 7 years of 98 patients (20 men, 78 women)  receiving a short metaphyseal reverse total shoulder arthroplasty (rTSA) prosthesis without a diaphyseal stem.

Mean age was 74.4 years (range, 38-93 years).  Indications were cuff tear arthropathy, 65; fracture sequelae, 12; rheumatoid arthritis, 13; failed rotator cuff repair, 3; cuff deficiency with loosening of anatomic prosthesis, 3; and acute trauma, 2; 17 of these were revisions.

Patients’ satisfaction (Subjective Shoulder Value) improved from 8 of 100 to 85 of 100. The Constant score improved from 14 to 59 (age- and sex-adjusted, 86; P < .0001). Range of motion improved from 47° to 129° in elevation, 10° to 51° in external rotation, and 21° to 65° in internal rotation.

21 patients (21%) had glenoid notching (18 grade 1-2; 3 grade 3). Other complications included

2 undisplaced fractures of the humeral metaphysis due to excessive bone impaction

1 glenoid rim cracked during preparation

2 early dislocations; 1 patient put weight on his shoulder in extension of the shoulder (to push himself out of chair) 1 week after surgery. The other was caused by an inferior osteophyte that hinged the liner to dislocate.

1 glenoid head disengaged from the baseplate due to soft tissue interposition

2  acromial fractures

6  late traumatic periprosthetic fractures caused by falls - two glenoid fractures and three proximal humeral (metaphyseal) fractures. 

1  displaced metaphyseal-diaphyseal periprosthetic fracture
.  Comment: While metaphyseal humeral components without a stem were developed to minimize bone resection and preserve bone,

it is unclear that they preserve more bone than an impaction grafted thin stem. Compare the x-ray above to one taken for our case from yesterday shown below. We fix the humeral component with impaction autografting, minimizing the risk of fracture at surgery and after.

Information about shoulder exercises can be found at this link.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
See from which cities our patients come.

See the countries from which our readers come on this post.