Recurrent dislocations of reverse total shoulder arthroplasty

Acromiohumeral Cerclage in Reverse Total Shoulder Arthroplasty for Recurrent

Instability

Recurrent shoulder instability is one of the most frequent complications following reverse total shoulder arthroplasty (rTSA); by contrast, instability is rare after anatomic total shoulder arthroplasty.

In many cases recurrent instability of an rTSA can be managed by correcting component malposition,  upsizing the diameter of the glenosphere, adjusting soft tissue tension, avoiding unwanted contact between the humeral component and use of a retentive liner for the humeral component.

However, some case are refractory to these approaches. 

These authors describe the 1 year outcomes for 10 patients (4 female/6 male average age 64 years) in which an acromiohumeral cerclage technique was used in which the humeral component was stabilized with nonabsorbable, high-tensile suture tape looped through transosseous acromial drill tunnels as an augment to other approaches to enhance stability.

The acromial holes:

The humeral fixation (left - through holes in prosthesis fin, right - around prosthesis neck): 

These patients had an average of 2.1 revisions prior to revision with suture cerclage

augmentation. Many had procedures prior to their index reverse total shoulder.

At followup, the VAS score decreased from an average of 5.9 to 1.6, the ASES score increased from an average of 28 to 80, and active forward elevation increased from 41 to 130. 

All patients remained stable with well-positioned prostheses since their final operations with no recurrent dislocations or acromial complications. Radiographs are seen below.

Comment: Instability after a reverse total shoulder can be a devastating complication. The results reported here are surprisingly good without recognized complications. Longer term followup with a larger series of patients will be important for assessing the risk of acromial fracture and failure of fixation. Interestingly, the authors state, "although we had no acromial complications with this technique in any patient at an average of 2 years postoperatively, we think there is merit to at least considering removing the cerclage after reasonable period of stability to avoid any catastrophic acromial complications."

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