REVISION SHOULDER ARTHROPLASTY WITH A REVERSED TOTAL PROSTHESIS

Abstract

Purpose of the study: Revision shoulder arthroplasty is generally considered to be a difficult procedure yielding modest improvement.

Material and methods: We report a prospective study of 45 patients, aged 69.8 years (range 49–85 years). Thirty-two patients had a simple humeral prosthesis and thirteen a total prosthesis. A reversed prosthesis was used for all revisions. The reasons for the revisions were classified into five groups: failure of prosthesis implanted for fracture (36%), glenoid problems of a total shoulder arthroplasty (24%), prosthetic instability (18%), failure of a hemiarthroplasty implanted for rotator cuff tear (11%), failure of a hemiarhtroplasty implanted for post-traumatic osteoarthritis (11%). The revision consisted in replacement with a reversed prosthesis. Patients were assessed pre and postoperatively using the Constant score for the clinical assessment and plain x-rays for the radiological assessment.

Results: Forty-one patients were reviewed at mean follow-up of 42.1 months (range 24–92). The four other patients died during the first two postoperative years. Subjectively, 73% of patients were satisfied. The Constant score improved from 187.7 to 55.6 on average. The best gain was obtained for the pain and daily activities scores.

Discussion: Revision shoulder arthroplasty provides only moderate improvement. Neer called a limited goal surgery. Results published on revision shoulder arthroplasty using a non-constrained prosthesis show that the functional gain is moderate. Revisio with a reversed total prosthesis gives better results because of the lesser impact of the cuff deficiency. The rate of complications after revision is greater than with first intention implantations.

Conclusion: Use of a reversed total shoulder prosthesis for revision shoulder arthroplasty provides encouraging results in terms of the mid-term functional outcome.