2019 ISAKOS Biennial Congress ePoster #1713
Metaphyseal Reverse Total Shoulder Arthroplasty without a Stem: Long-Term Results with 5- to 11-Years Follow-Up
Ofer Levy, MD, MCh(Orth), FRCS, Reading, Berkshire UNITED KINGDOM
Paolo Consigliere, MD, Reading, Berkshire UNITED KINGDOM
Andreas Leonidou, MD, Reading, Berkshire UNITED KINGDOM
Georgios Panagopoulos, MD, London UNITED KINGDOM
Oren Tsvieli, MD, Givot Bar ISRAEL
Caroline Witney-Lagen, MD, Reading, Berkshire UNITED KINGDOM
Luis Natera, MD, Barcelona SPAIN
Ruben Abraham, MD, FRCS, Reading, Berkshire UNITED KINGDOM
Giuseppe Sforza, Pratica Di Mare, Rome ITALY
Juan Bruguera, MD, Pamplona SPAIN
Ehud Atoun, MD, Karakur ISRAEL
Reading Shoulder Unit, Reading, Berkshire, UNITED KINGDOM
The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Innovative Design Orthopaedics, Verso TSA
Summary
5 -11 years long-term clinical and radiological outcomes using a short metaphyseal reverse total shoulder arthroplasty (rTSA) without a diaphyseal stem.
Abstract
Aim
To evaluate the 5 -11 years long-term clinical and radiological outcomes using a short metaphyseal reverse total shoulder arthroplasty (rTSA) without a diaphyseal stem.
Introduction
rTSA are increasingly used in recent years. Metaphyseal humeral components without a stem were developed to minimise bone resection and preserve bone.
Methods
172 consecutive shoulders underwent rTSA between 2005 to December 2011, 149 with short metaphyseal stemless implant and 23 with stemmed implant.
The average follow up was 89 months (6.25 years) (range 60 - 138 Months). There were 41 males and 131 females; the mean age at surgery was 74.3y (range 38-93y).
111 patients for severe rotator cuff deficiency: 86 cuff tear arthropathy, 19 for fracture sequelae, 24 for rheumatoid arthritis, 16 patients were after failed RC repair or massive irreparable cuff tear, 4 for osteoarthritis with cuff deficiency or eroded glenoid, 18 for failed anatomical prosthesis with cuff deficiency, and 5 for acute trauma. 13 patients (26 shoulders) underwent bilateral (staged) rTSA at that period.
50 patients were operated as revision arthroplasty (21 from stemmed implants to stemmed rTSA, 29 to short metaphyseal stemless rTSA (3 of them from stemmed implant to stemless implant).
Results
Patients’ satisfaction (SSV20) improved from 1.1/10 to 9.3/10. Mean Constant Score (for all diagnoses) improved from 15.9±8.6 preop to 59.7±20.4 at last follow-up. Age/sex adjusted Constant score improved from 22.6±12.3 preoperatively to 89.2±30.3 at the last follow-up (p<0.0001).
The mean active range of movement improved from 53.8° to 131.9° active elevation, 20.7° to 34.6° active external rotation and 32.3° to 68.8° active internal rotation. Radiographic analysis showed no lucencies, subsidence or stress shielding around the humeral or glenoid components.
Glenoid notching was found in 40 shoulders (23.2%) (34 grade 1-2 (19.8%) and 6 cases grade 3 (3.5%)).
Conclusion
The short metaphyseal rTSA (without a diaphyseal stem) design shows encouraging long-term results with excellent pain relief and shoulder function, restoration of good active range of motion and high patients’ satisfaction scores. The design of this implant seems to result in improved rotational movements, low incidence of glenoid notching and no implant loosening, subsidence or stress shielding.