Sunday, August 12, 2018

Failed shoulder arthroplasty with posterior instability.

Revision anatomic shoulder arthroplasty with posterior capsular plication for correction of posterior instability {Journal of Orthopaedic Surgery 26(3) 1–9 2018}.

These authors reported the clinical and radiographic outcomes, complications, and reoperations of posterior capsular plication (PCP) performed in 16 revision anatomic shoulders performed between 1975 and 2013.

Indications for revision arthroplasty included posterior instability in 15, glenoid loosening in 3, polyethylene wear in 2, and glenoid erosion in 1 shoulder. 

At the last follow-up, nine shoulders (56%) had absence of posterior radiographic subluxation. Five (31%) cases underwent reoperation due to persistent posterior instability. Complications were observed in seven (44%) cases. Complete pain relief was achieved in four (25%) shoulders. 
Results were excellent in two (13%), satisfactory in seven (44%), and unsatisfactory in seven (44%) shoulders.

The authors concluded that PCP to correct posterior instability during revision anatomic shoulder arthroplasty had an unacceptably high failure rate. 

Comment: What is especially interesting is that in these 16 cases, glenoid retroversion was felt to contribute to the posterior instability in only one, and that shoulder had 70 degrees of humeral retroversion combined with 30 degrees of glenoid retroversion.

We agree with the authors that posterior capsular plication is often not a robust technique for managing posterior instability. We prefer instead the use of an anteriorly eccentric humeral head component and rotator interval plication.

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