Reversed shoulder arthroplasty in cuff tear arthritis, fracture sequelae, and revision arthroplasty

Abstract

Background and purpose: Reversed shoulder arthroplasty may be used for severe arthropathy where conventional prostheses cannot restore the function sufficiently. We analyzed the medium-term results and potential complications of the reversed prostheses, and also the influence of etiology on the result. METHODS; 52 women and 7 men, average age 70 (60-82) years, were followed for mean 4 (2-7) years. The indications were cuff tear arthropathy (CTA) (23), fracture sequelae (20), and revision of a failed conventional arthroplasty (16).

Results: The average Constant score improved from 18 (2-55) points to 59 (17-96) points. It rose from 26 to 74 points in patients with CTA, from 12 to 48 in those with fracture sequelae, and from 10 to 54 points in revision arthroplasty. We also found an overall improvement in active forward flexion from 47 degrees to 105 degrees , and in active abduction from 46 degrees to 93 degrees . Scapular notching was seen in 51 shoulders. Radiolucent lines below the base-plate were present in 2 cases. There were no instances of loosening. Revisions were necessary in 15 patients: 5 with infections (all had had prior surgery), 5 with hematoma, 3 with dislocations, and 2 with disconnections of the shaft components.

Interpretation: Reversed prosthetic replacement is a suitable method for restoring function and attaining pain relief in severe arthropathies. The results in revision arthroplasty are less predictable, with complications and revision rates higher than those in CTA patients. The reversed prosthesis should therefore only be used when conventional methods have failed.

Figure 1.

Delta III prosthesis in CTA type V according to Hamada.

Figure 2.

Delta III prosthesis in fracture sequelae type IV according to Boileau and Walch, with persistent dislocation and healing of the fragments with massive deformation.

Figure 3.

Delta III prostheses after failed fracture of prosthesis due to necrosis of the tubercles, and resulting anterior–superior migration.

Figure 4.

Development of the Constant score adjusted for age and gender over the period of investigation (median values, interquartile range 25% and 75%, min., max., l = outlier that lie between 1.5 and 3 times the interquartile range).