These authors point out that while reverse shoulder arthroplasty (RSA) is a reliable, long-term treatment option for degenerative shoulder pathology, the functional outcomes degrade around the fifth year postoperation, particularly for internal and external rotation.
Using a consecutive database of 1953 RSA procedures performed for massive rotator cuff tear, cuff tear arthropathy, or primary glenohumeral osteoarthritis with major glenoid wear (retroversion > 25, humeral subluxation > 80%) at 7 French hospitals.
They compared the minimum 5 year clinical outcomes for RSAs in which the surgeon selected cemented humeral fixation and those in which the surgeon elected press-fit fixation. They investigated 2 matched cohorts: 56 RSAs with cemented stems and 56 RSAs with press-fit stems.
At a mean follow-up of 9.5 years, regardless of the fixation method, the RSA helped improve the Constant score (CMS) and active joint ROM postoperatively, except for internal and external rotation with elbow at side in the press-fit group. The CMS did not differ between groups.
Shoulder ROM was significantly better in the group with cemented stems for anterior elevation, abduction, and external and internal rotation with the elbow at the side.
The failure rate at the final follow-up with RSA revision was 5.4%. These revisions occurred after a mean of 126 months (118-143). This consisted of 2 revisions for aseptic glenoid loosening and 1 for aseptic humeral looseningd in the press-fit group and 1 revision for aseptic glenoid loosening in the cemented stem group
Tuberosity resorption, scapular notching, and osteopenia did not have a significant effect on the functional outcome.
Comment: In that the patients in the two groups were carefully matched, it is unclear why some surgeons elected cemented and some selected uncemented humeral component fixation. Perhaps the important difference between the two groups lies in the differences among surgeons who performed the RSA rather than in the method of humeral component fixation.
The authors mention the issue of stress shielding, which results from non-uniform distribution of the load from the implant to the bone.
In general this is more an issue with press fit than with implants inserted with either cement or impaction grafting. To see a YouTube of our technique for a reverse total shoulder arthroplasty with humeral component fixation using impaction grafting, click on this link.
===
How you can support research in shoulder surgery Click on this link.
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
Use the "Search" box to the right to find other topics of interest to you.
