Hemiarthroplasty as a salvage treatment for failed reverse total shoulder arthroplasty
These authors point out that due to the increasing use of the reverse total shoulder (RTSA), the numbers of complications and revision surgeries also increasing. When a failed RTSA cannot be re-revised to another RTSA, revision to a hemiarthroplasty may offer an alternative.
They queried their database for cases of failed RTSA revised to a hemiarthroplasty. A total of 21 out of 1237 RTSAs (1.7%) underwent salvage revision to hemiarthroplasty at a mean time of 20±21 months after the RTSA because revision to another RTSA was not possible. Of those, 12 were available for a minimum follow-up of 2 years.
The main indications were glenoid loosening (8/12), scapular spine fracture (2/12) and instability (2/21). Clinical outcome was analyzed at a mean follow-up period of 46 +- 26 months following revision to a hemiarthroplasty.
The revision significantly reduced pain, but shoulder function was not significantly improved.
Comment: Managing a failed reverse is challenging and the approach needs to be carefully tailored to the characteristics of the shoulder and the patient. Revision to another reverse, addressing baseplate fixation and instability is possible in many cases. In some cases, such as that below with two prior successive baseplate failures, conversion to a hemiarthroplasty with removal of the broken screws can provide pain relief and does not burn the bridge to a subsequent revision to RTSA in the future after things have settled down.
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