Single institution Clinical results of 139 cases of Revision of Reverse Shoulder arthroplasty with a minimum follow up of 2 years
The reverse shoulder arthroplasty (RSA) is attributed to a high rate of complications. This study evaluates the complications of the RSA requiring revision. The aim of the study is to assess the cause for revision and the complications and outcome of the revision RSA procedure.
From 2008 to 2014 a total of 1,483 RSA were performed at our institution. In this time period,139 patients underwent revision RSA surgery. The patients undergoing a revision RSA were retrospectively evaluated for their pre- and postoperative clinical and radiological outcome. The mean follow up was over two years.
The cause for revision (n= 139) was glenoid related (32%), infection (22%), instability (18%), acromial fractures (12%), periprosthetic humeral fractures (8%), arthrofibroses (4%), and others (4%). The majority of glenoid related revisions were attributed to malpositioned glenoid base plate and/or advanced notching. Instability was an early complication and in 81% of cases and was associated with significant proximal humeral bone loss (p value < 0.05). Some 45% of the humeral periprosthetic fractures were fragillity fractures and associated with significant oteopenia around the humeral stem. At a mean follow up of 3.2 years, the Constant score and subjective shoulder value (SSV) improved in all patients. A total of 30.3% of patients had to undergo at least one or more secondary surgical procedures. Multiple complications culminated in an end stage resection arthroplasty in 10 patients.
Discussion And Conclusion
Despite a high complication rate the majority of patients (73.3%) had significant improvement in their SSV and Constant score. Scapular notching with advanced component loosening and bone insufficiency of the acromion were factors which require a precise preoperative analysis and a customized operative strategy and a possibility of a two-stage procedure. In cases of proximal humeral bone loss reattachment of the soft tissue and muscular structures to the proximal humerus (autograft or prosthesis) was important to avoid future instability. The conjoint tendon plays a significant role in providing stability to the prosthesis and must be preserved during the surgery. The triad of instability, infection, and osteopenia culminates as multiple reoperations and the patients must be counseled for this in the outset.