Revision to reverse shoulder arthroplasty with retention of the humeral component

Werner, Birgit; Boehm, Dorota; Gohlke, Frank

doi:10.3109/17453674.2013.842433

Cited by 47 publications

(31 citation statements)

References 27 publications

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“…The most salient advantage involves reduction in the rate of periprosthetic humeral fracture during revision surgery (Figs. 6-A and 6-B) 12, 50,203,205,207 . Humeral implant design or improper stem position during the index procedure may prevent retention during revision 12, 203,207,208 .…”

Section: Evolving Trends In Shoulder Arthroplastymentioning

confidence: 99%

“…Raiss et al demonstrated a reduction in survivorship at 10 and 15 years after TSA performed with cement secondary to pain and implant loosening; revision procedures occurred at a mean of 8.8 years from the date of implantation 125 . The five RSA studies with minimum follow-up of 5 years noted scapular notching and instability as the most common complications 28 [33][34][35][36][37][38][39][44][45][46][47][48]50,51,53,54,[56][57][58][59]61,64,65,67,69,70,73,75,79,81,[88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]104,105,…”

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confidence: 99%

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Complications of Shoulder Arthroplasty

Bohsali

Bois

Wirth³

2017

The Journal of Bone and Joint Surgery

298

199

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d The most common complications after reverse shoulder arthroplasty in order of decreasing frequency included instability, periprosthetic fracture, infection, component loosening, neural injury, acromial and/or scapular spine fracture, hematoma, deltoid injury, rotator cuff tear, and venous thromboembolism (VTE).d The most common complications after anatomic total shoulder arthroplasty (TSA) in order of decreasing frequency were component loosening, glenoid wear, instability, rotator cuff tear, periprosthetic fracture, neural injury, infection, hematoma, deltoid injury, and VTE.d Glenoid component wear and loosening remain a common cause of failure after anatomic TSA, despite advances in surgical technique and implant design.d Diagnostic confirmation of infection after shoulder arthroplasty remains a challenge. In the setting of a painful and stiff shoulder after arthroplasty, the surgeon should have a heightened suspicion for infection. Inflammatory markers may be normal, radiographs may be inconclusive, and prosthetic joint aspiration may be negative for a causative organism.Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the author had a patent and/or copyright, planned, pending, or issued, broadly relevant to this work. 99:256-69 d http://dx.doi.org/10.2106/JBJS.16.00935 frequency) included instability, periprosthetic fracture, infection, component loosening, neural injury, acromial and/or scapular spine fracture, hematoma, deltoid injury, rotator cuff tear, and venous thromboembolism (VTE)The most common complications after anatomic TSA (in order of decreasing frequency) were component loosening, glenoid wear, instability, rotator cuff tear, periprosthetic fracture, neural injury, infection, hematoma, deltoid injury, and VTE (

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Section: Evolving Trends In Shoulder Arthroplastymentioning

confidence: 99%

mentioning

confidence: 99%

Complications of Shoulder Arthroplasty

Bohsali

Bois

Wirth³

2017

The Journal of Bone and Joint Surgery

298

199

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“…While neither group returned to full range of motion, they did achieve similar forward elevation to that previously described for revision of hemiarthroplasty to reverse total shoulder arthroplasty. 22 23) …”

Section: Discussionmentioning

confidence: 99%

Antibiotic Spacers in Shoulder Arthroplasty: Comparison of Stemmed and Stemless Implants

et al. 2017

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BackgroundAntibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers.MethodsAll spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed.ResultsThere were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 ± 8.4 years, p = 0.006). The groups had a similar percentage of each gender (stemless group, 45% male vs. stemmed group, 40% male; p = 0.742), body mass index (stemless group, 29.1 ± 6.4 kg/m2 vs. stemmed group, 31.5 ± 8.3 kg/m2; p = 0.354) and Charlson Comorbidity Index (stemless group, 4.2 ± 1.2 vs. stemmed group, 4.2 ± 1.7; p = 0.958). Operative time was similar (stemless group, 127.5 ± 37.1 minutes vs. stemmed group, 130.5 ± 39.4 minutes). Two stemless group patients had self-resolving radial nerve palsies. Within the stemless group, 15 of 22 (68.2%) underwent reimplantation with 14 of 15 having forward elevation of 109° ± 23°. Within the stemmed group, 12 of 15 (80.0%, p = 0.427) underwent reimplantation with 8 of 12 having forward elevation of 94° ± 43° (range, 30° to 150°; p = 0.300). Two stemmed group patients had axillary nerve palsies, one of which self-resolved but the other did not. One patient sustained dislocation of reverse shoulder arthroplasty after reimplantation. One stemless group patient required an open reduction and glenosphere exchange of dislocated reverse shoulder arthroplasty at 6 weeks after reimplantation.ConclusionsStemmed and stemless spacers had similar clinical outcomes. When analyzing all antibiotic spacers, over 70% were converted to revision arthroplasties. The results of this study do not suggest superiority of either stemmed or stemless antibiotic spacers.

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“…Yet, these criteria are subjective and depend on soft-tissue impairment as well as patient relaxation. Objective techniques for postoperative assessment of deltoid tension include evaluation of the acromio-epiphyseal distance compared to the contralateral humerus [9] the difference in pre-and postoperative acromio-metaphyseal distance corrected for abduction of the arm in revision arthroplasty [16], the difference of pre-and postoperative deltoid length with respect to the greater tuberosity [17] as well as bilateral scaled radiographs of the humerus [6,18,19]. The lack of bony landmarks in case of malunion or resorption of the greater tuberosity as well as extended humeral bone defects justifies the use of the contralateral side for pre-operative planning [6] as well as postoperative assessment of lengthening.…”

Section: Discussionmentioning

confidence: 99%