Wednesday, April 4, 2018

The promise of platform prostheses - unfulfilled

While there is in some sectors an enthusiasm for 'platform' prostheses that can be "easily" converted from anatomic to reverse and from reverse to anatomic without changing the humeral stem, our experience is that in a revision arthroplasty it is frequently the case that the stem needs removal and revision, whether or not it is a "platform" design.

Here's an example from yesterday's OR.

A patient presented to an outside surgeon with classical cuff tear arthopathy and retained active elevation. He might well have been a good candidate for a CTA prosthesis.

He was treated, however, with a reverse. Within the first month of surgery, he experienced dissociation of the glenosphere from the baseplate.

This was revised, but one month after the revision, the reverse arthroplasty dislocated

One month later his shoulder was revised to a hemiarthroplasty

which left him with a pseudo paralytic shoulder.

All of these revisions were 'accomplished' without change of the humeral stem.

At our revision, it became apparent that the stem was too high in the humerus. Revision required removal of the "platform" and a complete revision.

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