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. 2011 Jan;35(1):53-60.
doi: 10.1007/s00264-010-0990-z. Epub 2010 Mar 14.

Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure--midterm results

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Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure--midterm results

Matthias P Flury et al. Int Orthop. 2011 Jan.

Abstract

Our goal was to evaluate the objective and subjective midterm outcome after revision of a failed shoulder arthroplasty with a reverse design prosthesis. Twenty consecutive patients with 21 revisions of a primary shoulder arthroplasty using reverse shoulder prosthesis Delta III(®) were followed up postoperatively for a mean of 46 months including clinical and radiological examination. Complications were recorded and Constant score, DASH and SF36 were assessed. With the numbers given a significant reduction of pain was achieved from 8.7 to 3.0 (p < 0.001). There was a significant improvement of active flexion from 43° to 97° (p < 0.001) and active abduction from 44° to 90° (p < 0.001). However, at the same time, active external rotation with an adducted humerus decreased significantly from 26° to 12° (p = 0.012). The constant score improved significantly from 16.7 to 55.9 (p < 0.001). Sixteen patients (84%) rated their shoulder better or much better than before. In 43% an intraoperative and in 38% a postoperative complication occurred including two late stage infections which required prosthesis removal. Our results support the use of the reverse prosthesis as revision prosthesis. The reverse design helps to compensate functional deficits due to severe soft-tissue damage except active external rotation. Nevertheless, the revision is a technically demanding procedure reflected in a high rate of intraoperative complications. The rate of secondary infections of 10% remains a special concern.

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Figures

Fig. 1
Fig. 1
Delta III prosthesis (DePuy). The semi-constrained design stabilises the humeral head against the anterocranial directed force of the deltoid muscle
Fig. 2
Fig. 2
Range of motion (ROM) pre- and postoperatively. Flex flexion, Abd abduction, IR internal rotation, ER external rotation, * indicates significant value
Fig. 3
Fig. 3
Score results with normative data (* significant value)
Fig. 4
Fig. 4
Intra- and postoperative complications of the initial cohort of 21 patients including the patients with late stage infections
Fig. 5
Fig. 5
Fifty nine year old female patient with a long standing rheumatoid arthritis. Intraoperative fracture of the major tubercle, fixation with transosseous sutures. Six months after surgery with good integration of the major tubercle (left). Loosening of the Glenosphere 39 months after surgery (right)
Fig. 6
Fig. 6
A 62-year-old female patient. Left One year after revision arthroplasty with clinical signs of late stage infection (Streptococcus mitis/oralis). Center i.v.-gadolinium enhanced MRI with signs of a persisting chronic osteomyelitis after implant removal. Right Definitive resection situation after debridement
Fig. 7
Fig. 7
Four-part fracture of the humeral head treated elsewhere with a humeral head prosthesis (a). Missing greater tuberosity in the postoperative X-ray (b). Six-month postop cranialisation of the prosthesis (c). After revision with a reverse prosthesis Delta III (d)

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