Reverse shoulder arthroplasty for instability arthropathy
These authors conducted a retrospective cohort of 25 patients having a reverse total shoulder for arthritis after multiple dislocations or after a procedure for glenohumeral instability with a mean follow-up of 6.6 years. Eighty percent of the patients had a prior surgery for instability (36% of Latarjet or Bristow (7 patients) and capsular surgery for the others) and 20% had multiple closed reduction in their history. Mean delay between the initial procedure or first dislocation and the surgery was 50.3 years (SD 13.48 years). Thirteen percent of the 25 patients had a failed history of cuff repair (3 patients); an intact cuff was found for the others. Main risks factors for shoulder instability found were alcoholism in 15.4%, dementia in 7.7%, and Parkinson disease in 7.7% of the cases.
These authors conducted a retrospective cohort of 25 patients having a reverse total shoulder for arthritis after multiple dislocations or after a procedure for glenohumeral instability with a mean follow-up of 6.6 years. Eighty percent of the patients had a prior surgery for instability (36% of Latarjet or Bristow (7 patients) and capsular surgery for the others) and 20% had multiple closed reduction in their history. Mean delay between the initial procedure or first dislocation and the surgery was 50.3 years (SD 13.48 years). Thirteen percent of the 25 patients had a failed history of cuff repair (3 patients); an intact cuff was found for the others. Main risks factors for shoulder instability found were alcoholism in 15.4%, dementia in 7.7%, and Parkinson disease in 7.7% of the cases.
Active anterior elevation increased from 70° to 140° (p < 0.01) and external rotation from 9° to 21° (p = 0.02). The adjusted CS increased from 38 to 98 (p < 0.01).
Two early post-operative complications were collected: one superficial infection and one spine fracture perhaps related to a long superior baseplate screw.
At the latest follow-up, 38.10% had glenoid spurs, and 55% had scapular notching (see above x-ray).
These authors demonstrate that a reverse total shoulder can be an effective procedure for the management of post instability arthropathy. It is of interest that the average time from first dislocation to the shoulder arthroplasty was 50 years.
Here is a related article
Shoulder arthroplasty after prior anterior stabilization procedures: do reverses have better outcomes?
These authors compared the outcomes of 15 total shoulder arthroplasties (TSA) and 10 reverse total shoulder arthroplasties (RTSA) after anterior stabilization surgical procedures. The TSA group’s mean age at surgery was 54.9 years, with an average follow-up period of 4.0 years. The RTSA group’s mean age was 65.4 years, with an average followup period of 3.3 years.
The Simple Shoulder Test scores improved from averages of 3.9 to 8.9 in the TSA group and from 3.4 to 11.2 in the RTSA group.
Here is a related article
Shoulder arthroplasty after prior anterior stabilization procedures: do reverses have better outcomes?
These authors compared the outcomes of 15 total shoulder arthroplasties (TSA) and 10 reverse total shoulder arthroplasties (RTSA) after anterior stabilization surgical procedures. The TSA group’s mean age at surgery was 54.9 years, with an average follow-up period of 4.0 years. The RTSA group’s mean age was 65.4 years, with an average followup period of 3.3 years.
In the TSA group, 4 patients underwent prior bony procedures (27%), all of which were Bristow procedures. One underwent multiple other non-arthroplasty shoulder surgical procedures, and another underwent 4 previous arthroscopic surgical procedures. The remaining 11 patients underwent previous soft-tissue procedures that included the following: 7 with arthroscopic anterior labral repairs and 4 with open anterior capsular reconstructions.
In the RTSA group, 4 prior bony procedures (40%) were performed: 3 were Bristow procedures (1 patient also underwent a prior open rotator cuff repair) and 1 was a glenoid osteotomy. The remaining 6 patients underwent previous softtissue procedures that included the following: 3 with open anterior labral and capsular repairs (one of these with a total of 3 open reconstructive procedures), 2 with arthroscopic labral repairs, and 1 with a thermal capsulorrhaphy for instability with rotator cuff repair in the same setting.
In the RTSA group, 4 prior bony procedures (40%) were performed: 3 were Bristow procedures (1 patient also underwent a prior open rotator cuff repair) and 1 was a glenoid osteotomy. The remaining 6 patients underwent previous softtissue procedures that included the following: 3 with open anterior labral and capsular repairs (one of these with a total of 3 open reconstructive procedures), 2 with arthroscopic labral repairs, and 1 with a thermal capsulorrhaphy for instability with rotator cuff repair in the same setting.
In the TSA group, all the subscapularis tendons were deemed of adequate quality in the operative reports.
In the RTSA group, 3 subscapularis tendons were intact, 3 were poor quality, 2 were scarred, and 1 was deficient; in 1 case, the tendon quality was not recorded in the operative report. The intact subscapularis tendons were repaired. One of the poor-quality tendons and one of the scarred tendons were repaired using suture. The remaining subscapularis tendons were left as tenotomies.
In the TSA group the rotator cuff tendons were documented as being of adequate quality in all patients.
In the RTSA group, the supraspinatus was intact in 2, partially torn or poor quality in 3, and absent (or with a full-thickness tear) in 4. The infraspinatus was intact in 5, poor quality in 1, and absent (or with a full-thickness tear) in 3. The teres minor was intact in 6, partially torn or poor quality in 2, and absent in 1.
In the RTSA group, 3 subscapularis tendons were intact, 3 were poor quality, 2 were scarred, and 1 was deficient; in 1 case, the tendon quality was not recorded in the operative report. The intact subscapularis tendons were repaired. One of the poor-quality tendons and one of the scarred tendons were repaired using suture. The remaining subscapularis tendons were left as tenotomies.
In the TSA group the rotator cuff tendons were documented as being of adequate quality in all patients.
In the RTSA group, the supraspinatus was intact in 2, partially torn or poor quality in 3, and absent (or with a full-thickness tear) in 4. The infraspinatus was intact in 5, poor quality in 1, and absent (or with a full-thickness tear) in 3. The teres minor was intact in 6, partially torn or poor quality in 2, and absent in 1.
The Simple Shoulder Test scores improved from averages of 3.9 to 8.9 in the TSA group and from 3.4 to 11.2 in the RTSA group.
There were no complications or re operations in the RTSA group. TSA patients had a 33% complication rate and a 20% reoperation rate. 2 TSA patients underwent revision to RTSA. One TSA was converted to RTSA after aseptic glenoid loosening, and one was converted to RTSA because of subsequent rotator cuff failure. One TSA patient had a dislocation, which was treated with closed reduction and did not require further surgery.
Comment: Glenohumeral arthritis developing after prior surgery for anterior instability - "capsulorrhaphy arthropathy" - can be complicated by subscapularis, rotator cuff, glenoid bone deficiencies, and residual glenoid hardware. Each of these factors can complicate the surgeon's ability to achieve solid glenoid component fixation and a stable anatomic arthroplasty. It is of interest that the surgeons elected TSA in patients a decade younger than those having RTSA. The soft tissues were more compromised in the RTSA group.
Even though this is a small case series of patients that are dissimilar in some important ways, it does point out the challenges of attempting an anatomic TSA and the potential benefit of the RTSA in managing the complex pathology of arthritis after a prior instability repair.
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