T1 - The reverse shoulder prosthesis

AB - Purpose: the aim of this systematic literature review is to report clinical outcomes of reverse shoulder arthroplasty (RSA) used as a revision surgery following failure of the primary implant due to rotator cuff insufficiency. Methods: a systematic review was performed using the following key words: revision, shoulder, rotator cuff deficiency, outcome assessment, treatment outcome, complications. Studies eligible for inclusion in the review were clinical trials investigating patients in whom a primary shoulder arthroplasty implant with an incompetent rotator cuff was replaced with a reverse shoulder prosthesis. Results: nine articles were identified and further reviewed. The results refer to a total of 226 shoulders that were treated with RSA as revision surgery. The patients in the studies had a mean age ranging from 64 to 72 years and the longest follow-up was 3.8 years. Improvements in function and reduction of pain were shown by many studies, but the mean Constant score ranged from 44.2 to 56. High complication rates (of up to 62%) were recorded, and a mean reoperation rate of 27.5%. Conclusions: RSA as revision surgery for patients with rotator cuff deficiency is a valid option, and often the only solution available, but it should be limited to elderly patients with poor function and severe pain. Level of evidence: level IV, systematic review of levelI-IV studies.

KW - Reverse total shoulder arthroplasty

Complications and revision of the reverse prosthesis, a multicenter study of 457 cases.

Scapular notching in reverse shoulder arthroplasty.

The treatment options for patients with this condition are very few. Non-constraint conventional shoulder replacement; either resurfacing or stemmed hemiarthroplasty would provide them with pain relieve but no improvement of active motion and in cases of antero-superior escape will fail to improve their stability. Bi-polar hemiarthroplasty will probably do the same. The only option to improve these patients range of motion is by using a semi-constrained prosthesis with reversed geometry design, which allows the deltoid muscle to function better and improve the shoulder mobility. All designs of reversed shoulder prosthesis in the 70s have failed due to their excessive lateralisation of centre of rotation causing increased toque on the implant-bone interface of the glenoid component leading to glenoid loosening. Professor Grammonts idea of medialisation of centre of rotation towards the face of the glenoid and tensioning the glenoid muscle inferiorly has shown to be successful.

Reverse Shoulder Prosthesis (RSP) | DJO Global

Reversed shoulder prostheses aregaining popularity in recent years. Good mid-term results with restoration of active elevation have been reported. However there is a high complication rate with a stemmed prostheses ranging between 24% to 50% in different series and many of them require further surgery.

Reverse shoulder arthroplasty: clinical results, complications, revision.
Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency.

A review of reverse total shoulder arthroplasty, ..

So, a reverse prosthesis should be used in patients with very disabling arthropathy and a massive cuff tear and who are over seventy (at least sixty-five) years old.

Reverse total shoulder arthroplasty: a review of results according to etiology.

Posterior dislocation of a reverse total shoulder arthroplasty :

We observed a higher complication rate and wider variety of complications and technical pitfalls associated with the reverse prosthesis than previously reported. We showed there were more complications in the first 10 procedures performed than in the second 10. In our study, the learning curve for our experienced shoulder surgeon appeared to be seven patients, after which the complication rate decreased. These findings are important for any surgeon contemplating or currently performing reverse total shoulder arthroplasty []. Comparison of our complication rate with published rates (Table ) confirms the major source of surgical pitfalls and complications is related to glenoid preparation and baseplate insertion (Table ). However, few studies focus on intraoperative complications or report surgical pitfalls as potential complications. The number of screws required for adequate fixation of the baseplate is unknown (at least one reverse prosthesis system has no anterior or posterior screws), and screws with poor fixation may not affect long-term results. The deltopectoral approach is associated with a higher instability rate than the superior approach, and this may have had an impact on the complication rate in our study [].

Complications with the Reversed Prosthesis: ..

The major limitation of our study was the small sample size. A larger sample size would have provided greater precision for our complication rate estimates. We also would have been able to test for interactions between independent variables. For example, based on the observed rate of postoperative complications, it would have been necessary to follow at least 72 participants in each cohort (total, 144) to achieve an 80% power analysis to detect a difference between the two groups. However, our study shows that previous surgeon experience did not seem to affect the postoperative complication rate in the first compared with the second 10 patients, so additional study with larger numbers of patients is warranted to evaluate if there is such an effect. Another limitation was the short-term followup. Without longer-term followup, it is not possible to determine the influence of the surgical pitfalls or the complications on the final clinical result. Because we did not evaluate preoperative or postoperative function or patient satisfaction, the effect of these pitfalls and complications on the final outcome or long-term results is unknown. Our findings should be interpreted in light of two other factors. First, the experience of one surgeon may not be extrapolated to that of other surgeons whose experience levels might vary. Reverse prosthesis surgery is difficult with a high early-experience iatrogenic morbidity even for more experienced shoulder surgeons; although it might be inferred less experienced surgeons would have even more difficulty, we did not address this point. Second, the intraoperative and postoperative complications specific to the reverse prosthesis may be related to the implant designs used and may not apply to other reverse prosthesis systems.