Wednesday, January 17, 2018

Grammont-style reverse shoulder arthroplasty - avoiding humeral complications

Long-term humeral complications after Grammont-style reverse shoulder arthroplasty

These authors analyzed humeral complications in follow-up of 1035 reverse total shoulders (RSAs) with a minimum 5-year follow-up (implanted in 7 specialized shoulder centers between 1993 and 2010)

A 3.3% rate of postoperative humeral complications was found:17 cases (1.6%) with postoperative humeral fractures, 15 cases (1.4%) with aseptic humeral loosening, and 3 cases (0.3%) with humeral stem disassembly.

Humeral complications were more frequent in RSAs implanted for tumors, fracture sequelae, and revision for failed arthroplasty. Humeral complications after RSA are not rare, increase with longer follow-up, and have a negative impact on functional outcomes. Postoperative humeral fractures are more frequent in elderly patients, operated on through a superior approach, and after cemented stem implantation. In the absence of associated humeral loosening, conservative treatment should be preferred. Proximal humeral bone loss (due to revisions and tumors) is the most significant risk factor for humeral loosening.

Comment: The risk of some of these complications may be lowered by modifications in technique or in the implant. For example the risk of fracture at the tip of a cemented implant 

can be reduced by fixation with bone preserving impaction grafting, which avoids the distal stress riser.

 The risk of component disassembly

can be lowered by using a monoblock humeral component

Bone quality and bone quantity are often compromised in RSA, especially in elderly patients and in the setting of revision. In such cases, it is important to optimize implant design and surgical technique as well as minimizating of the risk of falls. 

Our technique of reverse total shoulder arthroplasty can be found at this link.