BackgroundAs reverse total shoulder arthroplasty (rTSA) becomes a common treatment option in the revision setting, common problems associated with Grammont’s design such as scapular notching, instability, and rotator cuff weakening occur. Design changes associated with superior outcomes in primary rTSA, such as glenoid or humeral lateralization have not yet been examined in the revision settings. The purpose of this consecutive series of revision rTSA is to evaluate the clinical and radiological short-term results after aseptic and septic revision rTSA and explore potential benefits of metallic glenoid and humerus lateralization. MethodsIn this study, patients treated with a rTSA between 2014 and 2020 after failed shoulder arthroplasty were included. Fifty-nine consecutive patients were divided into comparative groups using lateralized rTSA with metallic baseplate augmentation (latrTSA) and additional humeral lateralization using a 145° onlay curved stem (bi-latrTSA); or no baseplate offset with a Grammont-type 155° stem (non-latrTSA). Further, outcome of post-infection revision rTSAs was compared to aseptic loosening. Constant-Murley-Score (CS), Subjective-Shoulder-Value (SSV), shoulder range of motion (ROM) including Apley’s scratch test, abduction strength and pain levels were assessed. Radiographs were reviewed for implant loosening, scapular notching, fractures and osteolysis. Lateralization (LSA) and Distalization Shoulder Angle (DSA) were measured at final follow-up. ResultsThirty-eight patients showed significant improvement in all functional measurements at final two-year follow-up compared to baseline (p<0.01). There were no significant differences in favor of glenoid or bipolar lateralization. However, no scapular notching was seen in patients with both humeral and glenoid lateraliazion (non-latrTSA: 33%; latrTSA: 8%; bi-latrTSA: 0%; p=0.103), with no signs of implant loosening. Patients with bi-latrTSA showed significantly greater LSA (p=0.017); DSA was lower, but not significantly (p=0.230). Post-infectious rTSA (n=17; 45%) presented better internal rotation (p=0.036). The overall complication rate was 16% and 8% leading to revision. ConclusionRTSA is a viable option for revision cases and presents good results after failed shoulder arthroplasty, including the infected shoulder. The effect of metallic augmentation on clinical results is not comparable to those in literature in primary rTSA setting due to advanced preoperative medialization. However, scapular notching was prevented in all cases with bipolar lateralization.
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