Long – Term survivorship and clinical and radiological follow – up of the primary uncemented Delta III reverse shoulder prosthesis

Ochten, Johannes H.M. van; Pluijm, Marco van der; Pouw, M.H.; Felsch, Quinten; Heesterbeek, Petra J.C.; Vos, Maarten J. de

doi:10.1016/j.jor.2019.03.007

Cited by 18 publications

(8 citation statements)

References 33 publications

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“…Second, the revision rate in this study (4.7%) was lower than that reported for similar prostheses both over comparable (7.3–25%) and longer follow-up periods (45%) [ 7 , 24 , 27 ]. Lastly, the patients in this study had high midterm implant survival rates that were within the range of recently published reports [ 25 , 28 ].…”

Section: Discussionsupporting

confidence: 83%

“…Second, the revision rate in this study (4.7%) was lower than that reported for similar prostheses both over comparable (7.3-25%) and longer follow-up periods (45%) [7,24,27]. Lastly, the patients in this study had high midterm implant survival rates that were within the range of recently published reports [25,28]. This study's main strengths were its midterm follow-up and multicenter setup using a reverse shoulder prosthesis with a soft-on-hard bearing couple.…”

Section: Discussionsupporting

confidence: 63%

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Reverse total shoulder arthroplasty in massive rotator cuff tears: does the Hamada classification predict clinical outcomes?

Kääb

Kohut

Irlenbusch³

et al. 2021

Arch Orthop Trauma Surg

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Introduction Reverse total shoulder arthroplasty (RTSA) is a widely recognized treatment to reduce pain and improve shoulder function for patients in various disease stages of cuff tear arthropathy (CTA). However, it remains unclear whether outcomes after RTSA depend on the preoperative stage of CTA. Therefore, this study evaluated whether the Hamada classification influences midterm clinical outcomes after RTSA. Materials and methods In this multicenter observational study, patients underwent inverted bearing RTSA for massive rotator cuff tears or CTA. Shoulders were grouped into those with (Hamada grades 4a, 4b, and 5) and those without (Hamada grades 1, 2, and 3) glenohumeral arthritis. Clinical outcomes, including range of motion, Constant score, American Shoulder and Elbow Surgeons score, and visual analog scale for pain and satisfaction, were determined preoperatively and at 24 and > 30 months. All complications were recorded, and survival free from any implant component revision was calculated. Results Overall, 202 patients (211 shoulders) were treated with RTSA at a mean age of 75.8 ± 6.6 years (range 41.9–91.6 years). Of these, 144 patients (151 shoulders) were available for a mean follow-up of 79.9 ± 24.7 months (range 30.2–132.3 months). No significant between-group differences were found for clinical outcomes at 24 and > 30 months (P > 0.05). Furthermore, the Hamada classification did not correlate with clinical outcomes at 24 (P = 0.98) and > 30 months (P = 0.29). Revision-free implant component survival was similar between groups (P = 0.17). Postoperative complications were found in 11 shoulders, of which 10 required revision. Conclusions Inverted bearing RTSA was found to be an effective treatment with similarly good midterm clinical outcomes, similar revision rates, and high implant survival rates in every stage of massive rotator cuff tears. Overall, the preoperative Hamada classification did not influence clinical outcomes or complications after RTSA.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 63%

Reverse total shoulder arthroplasty in massive rotator cuff tears: does the Hamada classification predict clinical outcomes?

Kääb

Kohut

Irlenbusch³

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

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“…One can expect that the low revision rate of 2.5% in the rTSA group will increase over time. Van Ochten et al reported long-term results of reversed shoulder arthroplasty with a revision rate of 8.2% after 9 years [34]. Although this is a substantial increase, the long-term revision rate of plate fixation is still considerably higher [35].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction or replacement? A challenging question in surgical treatment of complex humeral head fractures in the elderly

Müller

Greve

Crönlein

et al. 2021

Arch Orthop Trauma Surg

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Introduction Surgical treatment of complex humeral head fractures in the elderly is challenging due to osteoporotic bone, comorbidities and reduced compliance. The treatment strategy (reconstruction versus replacement) should allow for a functional aftercare and result in a high patient satisfaction. Major complications leading to surgical revision are crucial and should be avoided. The purpose of this study was to analyse the major complication rate leading to surgical revision and the patient-based outcome in complex humeral head fractures of the elderly population treated either using locking plate fixation (LCP) or reversed total shoulder arthroplasty (rTSA). Materials and Methods All patients older than 65 years surgically treated due to a four-part fracture of the proximal humerus between 2003 and 2015 were enrolled in our retrospective study. Major complications and revision rates were recorded and functional outcome was assessed using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score. Results A cohort of 103 patients with a mean age of 73.4 ± 6.2 years suffering from four-part fractures of the humeral head were enrolled. 3 patients were treated using the LCP fixation compared to 40 rTSAs. There were no significant differences in the patient-reported functional outcome. The revision rate was significantly higher in the LCP group (10/63; 15.9%) compared to the rTSA group (1/40; 2.5%). Reasons for revision were avascular head necrosis, cut-out of screws, secondary dislocation of the greater tuberosity and hypersensitivity to metal. Conclusions Reversed total shoulder arthroplasty and locking plate fixation are both established surgical procedures for the management of complex proximal humerus fractures in the elderly leading to similar functional results. However the revision rate in the rTSA group was significantly lower. Primary rTSA should, therefore, be favoured in multimorbid elderly patients with an increased complication risk to avoid repeated anaesthesia.

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“…For determination of risk of bias, the Risk Of Bias In Non-Randomized Studies -of Interventions tool by Cochrane was used for non-Randomized Controlled Trials (RCTs) and the Risk Of Bias 2 tool for RCTs. 51,52 Both authors one and 2 assessed risk of bias, and in case of disagreement, author 5 and 6 were consulted. A more intense rehabilitation protocol was defined as a confounder and BIO and glenoid grafting as cointerventions.…”

Section: Risk Of Biasmentioning

confidence: 99%

Influence of humeral stem inclination in reverse shoulder arthroplasty on range of motion: a meta-analysis

Holsters

Sadeghi

Gendera

et al. 2021

JSES Reviews, Reports, and Techniques

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The reverse shoulder arthroplasty, as introduced by Grammont, has had many modifications over time. One of these modifications was reducing the neck-shaft angle (NSA) from 155 degrees to 135 degrees. Biomechanical studies indicated that lowering the NSA increases external rotation and reduces abduction and the incidence of scapular notching. The purpose of this study was to compare range of motion, functional outcome measures, and complications in patients undergoing reverse shoulder arthroplasty, depending on the NSA, through a systematic review and meta-analysis. Methods: A literature search was conducted (articles published from January 1985 to January 2020) in the PubMed/MEDLINE, Embase, and CINAHL databases and the Cochrane library. All studies reporting outcomes after primary reverse shoulder arthroplasty for osteoarthritis and rotator cufferelated disease were included. Patients were divided into 2 groups: a medialized design (MD) with an NSA of 150-155 degrees and a lateralized design (LD) with an NSA of less than 150 degrees. Pooled effects were calculated in the form of mean differences and 95% confidence intervals (CIs). Risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies -of Interventions tool for non-Randomized Controlled Trials and the Risk Of Bias 2 tool for Randomized Controlled Trials. Results: A total of 21 studies and 3134 arthroplasties were included: 1366 with an MD and 1678 with an LD. The mean age was 73.0 years (MD 74.0 and LD 72.5). A direct comparative meta-analysis was not feasible, and therefore, all data were compared using the minimal clinically important difference. The MD group demonstrated a larger improvement in abduction (56.76 , 95% CI 37.03-76.49) than the LD group (48.52 , 95% CI 28.27-68.78), however the LD group demonstrated a larger improvement in external rotation with the arm at the side (MD: 7.69 , 95% CI 0.01-15.37; LD: 16.14 95% CI 7.18-25.09). When looking at the postoperative range of motion, the MD group had more abduction than the LD group (MD: 136.28 ,). Both designs had a comparable improvement in the Constant Murley score (MD 42.04 points, LD 41.14 points). Lowering the NSA was accompanied by a decrease in dislocation rate (MD: 4.6%; LD: 1.4%; P value .037) and notching rate (MD: 40.3%; LD: 17.3%; P value <.0001). Conclusion:In our analysis, lowering the NSA decreases the amount of abduction but increases the amount of external rotation. This change in range of motion is accompanied by less scapular notching and dislocations. There is no clear impact on functional outcome measures.

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Long – Term survivorship and clinical and radiological follow – up of the primary uncemented Delta III reverse shoulder prosthesis

Cited by 18 publications

References 33 publications

Reverse total shoulder arthroplasty in massive rotator cuff tears: does the Hamada classification predict clinical outcomes?

Reverse total shoulder arthroplasty in massive rotator cuff tears: does the Hamada classification predict clinical outcomes?

Reconstruction or replacement? A challenging question in surgical treatment of complex humeral head fractures in the elderly

Influence of humeral stem inclination in reverse shoulder arthroplasty on range of motion: a meta-analysis

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