Revision Of Reverse Shoulder Arthroplasty Research Articles

Outcomes following revision of a failed primary reverse shoulder arthroplasty.

Reverse shoulder arthroplasty (RSA) has become the most common type of shoulder arthroplasty used in the UK, and a better understanding of the outcomes after revision of a failed RSA is needed. The aim of this study was to review the current evidence systematically to determine patient-reported outcome measures and the rates of re-revision and complications for patients undergoing revision of a RSA. MEDLINE, Embase, CENTRAL, and the Cochrane Database of Systematic Reviews were searched. Studies involving adult patients who underwent revision of a primary RSA for any indication were included. Those who underwent a RSA for failure of a total shoulder arthroplasty or hemiarthroplasty were excluded. Pre- and postoperative shoulder scores were evaluated in a random effects meta-analysis to determine the mean difference. The rates of re-revision and complications were also calculated. The initial search elicited 3,166 results and, following removal of duplicates and screening, 13 studies with a total of 1,042 RSAs were identified. An increase in shoulder scores pre- to postoperatively was reported in all the studies. Following revision of a RSA to a further RSA, there was a significant increase in the American Shoulder and Elbow Surgeons Score (mean difference 20.78 (95% CI 8.16 to 33.40); p = 0.001). A re-revision rate at final follow-up ranging from 9% to 32%, a one-year re-revision rate of 14%, and a five-year re-revision rate of 23% were reported. The complication rate in all the studies was between 18.5% and 36%, with a total incidence of 29%. This is the largest systematic review of the outcomes following revision of a RSA. We found an improvement in functional outcomes after revision surgery, but the rates of re-revision and complications are high and warrant consideration when planning a revision procedure.

The use of computer navigation in reverse shoulder arthroplasty revision: a case report.

Revision shoulder surgery is always a challenge, especially in the management of periprosthetic joint infection. Staged surgery with antibiotic-loaded cement spacer, seems to yield satisfactory and encouraging results. New technologies such as computer navigation are additional tools that could aid surgeons in particular conditions where the native anatomy is distorted. This study presents the unique experience of revision shoulder surgery with computer navigation assistance. Benefits related to this approach could lead to better prosthesis longevity and survivorship.

Trends in outcomes following aseptic revision shoulder arthroplasty.

As the incidence of anatomic and reverse total shoulder arthroplasty (TSA, RSA) increases, revision procedures will also increase with a corresponding need for counseling patients regarding outcomes. We hypothesized that different revision categories would have different complication profiles depending on both the indication as well as the nature of the prior hardware. A retrospective review of 1773 cases performed at a single tertiary health system utilized case postings and diagnoses to identify revision shoulder arthroplasty cases. Revisions were classified based on the prior hardware present, with basic demographics and other perioperative and postoperative outcomes recorded within the limits of available follow-up. 166 surgical cases involving revision of prior shoulder arthroplasty metal hardware were identified with an average follow-up of 1.0years. Immediate perioperative outcomes of revision cases were similar relative to the companion cohort of 1607 primary cases. 137 cases (83%) required no further revision surgery, while 19 cases (11%) underwent aseptic revision, and 10 cases (6%) were revised for periprosthetic infection. RSA hardware revised to another RSA had the highest repeat revision rate relative to the other revision categories (32% vs < 14%). Revision of reverse shoulder arthroplasty to a repeat reverse has the highest rate of subsequent all-cause revision, and these repeat revisions often occurred for periprosthetic infection. Despite a relatively high long-term complication rate following revision shoulder arthroplasty, immediate perioperative outcomes remain similar to primary cases, providing some preliminary evidence for policymakers considering inclusion in future value-based care models. Level III Treatment Study.

Revision of failed reverse shoulder arthroplasty—a point of no return?

Abstract Background The rate of complications after revision of reverse shoulder arthroplasty (RSA) is higher than it is in primary RSA, depending on the type of surgical intervention, the follow-up time, the preoperative condition of the patient, and the experience of the surgeon. Objective The current article represents an evaluation of the authors’ experiences with revisions of RSA and a review of literature, in order to define prognostic parameters and surgical options for the most common modes of failure. Materials and methods Between 2010 and 2019, 136 revisions of RSA were performed. Mean age of the patients at surgery was 68.3 years (29–88 years). The main indication was instability in 24 patients and chronic infection in 34. Aseptic loosening of the stem was the main indication in 15 and aseptic loosening of the baseplate in 23 patients. Periprosthetic fractures were present in 21 patients. Fractures of the scapular spine were operated on in 6 and surgery was performed for progressive notching due to malposition of the glenosphere in 4 patients. Results Staged procedures, use of allografts, and custom-made implants are common, especially for chronic infections and severe bone loss. Most of the patients (88.2%) were treated successfully. Two salvage procedures and two retentions of spacers occurred. We identified risk groups for re-revision: chronic dislocations, chronic infections, advanced bone loss, and scapular spine fractures. We observed a shift of indications and techniques, often related to the design of the implants. Conclusion These results confirm that careful preoperative planning, special implants, and a high level of experience are mandatory. With time, the authors developed an algorithm for certain indications because it was recognized that failures are often of multifactorial origin. Today, numerous implant designs which differ considerably in biomechanical features and failure modes are available. This makes revisions of RSA more complex than it was in the past.

Revision surgery of reverse shoulder arthroplasty

There is limited knowledge regarding revision of reverse shoulder arthroplasty (RSA). This study assesses reasons for failure in RSA and evaluates the outcomes of revision RSA. Between 1997 and 2009, 37 patients with RSA had revision surgery. Clinical and radiologic examinations performed preoperatively and at 3 months, at 6 months, and then annually postoperatively were analyzed retrospectively. Patients were reviewed with a minimum 2-year follow-up. The most common causes for RSA revision were prosthetic instability (48%); humeral loosening, derotation, or fracture (21%); and infection (19%). Only 2 patients (3%) had to be reoperated on for glenoid loosening. More than 1 re-intervention was performed in 11 patients (30%) because of recurrence of the same complication or appearance of a new complication. Underestimation of humeral shortening and excessive medialization were common causes of recurrent prosthetic instability. Proximal humeral bone loss was found to be a cause for humeral loosening or derotation. Previous surgery was found as a potential cause of low-grade infection. At a mean follow-up of 34 months, 32 patients (86%) had retained the RSA whereas 2 patients (6%) had undergone conversion to humeral hemiarthroplasty and 3 (8%) to a resection arthroplasty. The mean Constant score in patients who retained the RSA increased from 19 points before revision to 47 points at last follow-up (P < .001). Even if revision may lead to several procedures in the same patient, preservation or replacement of the RSA is largely possible, allowing for a functional shoulder. Full-length scaled radiographs of both humeri are recommended to properly assess humeral shortening and excessive medialization before revision.

Reverse Prostheses in Arthropathies With Cuff Tear: Are Survivorship and Function Maintained Over Time?

The use of reverse shoulder arthroplasty has considerably increased since first introduced in 1985. Despite demonstrating early improvement of function and pain, there is limited information regarding the durability and longer-term outcomes of this prosthesis. We determined complication rates, functional scores over time, survivorship, and whether radiographs would develop signs of loosening. We retrospectively reviewed 527 reverse shoulder arthroplasties performed in 506 patients between 1985 and 2003. Clinical and radiographic assessment was performed in 464 patients with a minimum followup of 2 years and 148 patients with a minimum followup of 5 years (mean, 7.5 years; range, 5-17 years). Cumulative survival curves were established with end points being prosthesis revision and Constant-Murley score of less than 30 points. Eighty-nine of 489 had at least one complication for a total of 107 complications. Survivorship free of revision was 89% at 10 years with a marked break occurring at 2 and 9 years. Survivorship to a Constant-Murley score of less than 30 was 72% at 10 years with a marked break observed at 8 years. We observed progressive radiographic changes after 5 years and an increasing frequency of large notches with long-term followup. Although the need for revision of reverse shoulder arthroplasty was relatively low at 10 years, Constant-Murley score and radiographic changes deteriorated with time. These findings are concerning regarding the longevity of the reverse shoulder arthroplasty, and therefore caution must be exercised when recommending reverse shoulder arthroplasty, especially in younger patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.