Wednesday, November 14, 2018

Reverse total shoulder - failure by baseplate loosening

Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty

These authors analyzed 202 shoulders that underwent primary or revision reverse total shoulder (RSA) with a DJO prosthesis at a minimum 2-year follow-up.

Presumed aseptic baseplate loosening (AGBL) occurred in 6 shoulders (3.0%). The incidence of AGBL after revision RTSA (10%) was significantly higher than that after primary RTSA (1.2%; P = .014). There were significant associations between AGBL and the use of bone graft and the use of nonlocking screws. 

Multiple logistic regression analysis showed that the use of all peripheral nonlocking 3.5-mm screws and the use of bone graft were independent risk factors for AGBL.

Here is an example of baseplate loosening at 13 months after RSA associated with severe scapular notching.

Here is an example of central screw failure at 20 months after RSA, possibly associated with incomplete seating of the baseplate.

Our approach is to avoid bone grafting of the baseplate except in the rare case when good bone purchase cannot be achieved with the central screw, to assure good seating of the glenoid baseplate, and to use for peripheral locking screws.
We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

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