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. 2022 Apr 19;11(9):2274.
doi: 10.3390/jcm11092274.

Medium- to Long-Term Outcomes after Reverse Total Shoulder Arthroplasty with a Standard Long Stem

Matthias Bülhoff  1 , Felix Zeifang  2 , Caroline Welters  3 , Tobias Renkawitz  1 , Marcus Schiltenwolf  1 , Anna-K Tross  1
Affiliations

Medium- to Long-Term Outcomes after Reverse Total Shoulder Arthroplasty with a Standard Long Stem

Matthias Bülhoff et al. J Clin Med. .

Abstract

Background: Long-term clinical and radiographic outcome data after standard cemented long-stem reverse shoulder arthroplasty (RSA) remain underreported. The aim of this study is to report on medium- to long-term data of patients over 60 years of age. Methods: The same type of RSA (Aequalis Reverse II, Memphis, TN, USA) was implanted in 27 patients with a mean age of 73 years (range 61−84). Indications for RSA were cuff tear arthropathy (CTA) in 25 cases and osteoarthritis (OA) in two cases. Pre- and postoperative Constant Score was assessed and component loosening, polyethylene wear, scapular notching and revision rates were recorded at a mean clinical follow-up (FU) of 127.6 months (SD ± 33.7; range 83−185). Results: The mean-adjusted CS (aCS) improved from 30.0 (range 10−59) to 95.0 (range 33−141) points (p < 0.001). Glenoid loosening was found in two (9.1%) and stem loosening was found in three (13.6%) cases. Polyethylene wear was observed in four (18.2%) cases. Scapular notching appeared in 15 (68.2%) cases but was not associated with poor aCS (p = 0.423), high levels of pain (p = 0.798) or external rotation (p = 0.229). Revision surgery was necessary in three (11.1%) cases. Conclusions: RSA with a cemented standard long stem leads to improvement in forward elevation, abduction and pain after a mean FU of 10 years. However, external rotation does not improve with this prosthetic design. Moreover, scapular notching is observed in the majority of cases, and revision rates (11.1%) as well as humeral loosening rates (13.6%) remain a concern. Level of evidence: Level 4, retrospective cohort study.

Keywords: glenoid loosening; humeral loosening; polyethylene wear; reverse arthroplasty; scapular notching; shoulder.

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Conflict of interest statement

Matthias Bülhoff: The author, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Felix Zeifang: The author, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Caroline Welters: The author, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Tobias Renkawitz: Tobias Renkawitz reports research funding/travel expenses and/or paid speaking engagements by the German Federal Ministry of Education and Research (BMBF), The German Federal Ministry for Economic Cooperation and Development (BMZ), Otto Bock Foundation, Stiftung Oskar-Helene-Heim Berlin, DePuy Int, Zimmer, Aesculap/B. Braun, AE, the Vielberth Foundation, German Society of Orthopaedics and Traumatology (DGOU), the German Association of Orthopaedics and Orthopaedic Surgery (DGOOC) and the Professional association for orthopedics and trauma surgery (BVOU). TR is associate editor of “Der Orthopäde” and “Der Unfallchirurg” (Springer Heidelberg, Berlin, New York) and member of the International Advisory Board of the Journal of the American Academy of Orthopaedic Surgeons (AAOS). Marcus Schiltenwolf: The author, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Anna-Katharina Tross: The author, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Figures

Figure 1
Figure 1
Flow chart. RSA = reverse shoulder arthroplasty; RA = rheumatoid arthritis; PTA = post traumatic arthritis; CTA = cuff tear arthropathy; FU = follow-up.
Figure 2
Figure 2
Survival analysis.
Figure 3
Figure 3
Scapular notching. (A): Anteroposterior radiograph of a right shoulder one-year postoperatively. (B): Anteroposterior radiograph of a right shoulder eight years postoperatively with scapular notching grade three according to the classification of Sirveaux [10]. Blue arrow demonstrating the area of scapular notching at the inferior glenoid.
See this image and copyright information in PMC

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