Abstract
Aim: To show that the Delta III Total Shoulder Replacement (TSR) Prosthesis is an alternate treatment for complex proximal humeral fracture sequelae (Type 3 & 4)
Methods: This is a prospective outcome study involving 10 patients (mean age (71.5 yrs). All patients failed conservative treatment with a mean time to surgery of 10.5 (+/− 11.5) months and a mean follow up of 8.2 months (6–24mnths). All patients underwent a Delta III TSR via McKenzie approach by a single surgeon.
Patients were assessed with constant and age adjusted Constant scores, radiographs and subjective questionnaire and whether they were satisfied at 6 weeks, 3, 6, 12, 24 months.
Results: At 6 months, age adjusted Constant scores changed form a mean 8.9 (5.3) pre-op to 50.1 (20.9). Six patients were satisfied, 2 unsure and 2 unsatisfied; elevation improved the most, with external rotation the least affected. Age adjusted power increase by 40.4 %, with a subjective function (10 points) improving by 32.6 %. X-rays at 6 months showed two glenoid notches in contact with the inferior screws. Three patients underwent revision surgery (total 5 revisions) for acute post – operative dislocations – all had inserts changed. Intra-operative tension assessment (by means of anterior dislocation of the humerus) was found to be a useful test of stability. Revision surgery found to be a significant predictor of poorer function at 6 months. (p< 0.025). No stem failures noted. Significantly better constant scores achieved with shorter period of time from fracture to delta replacement (p< 0.045). A single wound infection was treated successfully with oral antibiotics.
Conclusion: The results of the Delta III TSR in this difficult group of patients, appear satisfactory in terms of patient satisfaction, subjective and objective functional assessment and 6 months prosthesis survival (100%), and appear to offer a better functional outcome than hemiarthroplasty.
Correspondence should be addressed to BESS c/o BOA, 35-43 Lincoln’s Inn Fields, London WC2A 3PE
