SH1: JOINT REPLACEMENT OF THE SHOULDER – CONVENTIONAL OR INVERSE THE CASE FOR AND AGAINST

Abstract

Objective: To analyse the author’s personal use of shoulder replacements over the past 5 years, to report on his personal experience and to review the published literature on the results from both conventional and inverse Total Shoulder Replacement. Methodology: The author has kept a logbook of all his operations since 1986. Nottingham is a tertiary referral centre for shoulder surgery. The numbers of Shoulder Replacement operations carried out from 2004 to 2008 has been analysed, looking specifically at the proportion of Inverse Shoulder replacements being inserted. The published literature has been reviewed to identify the success and failure rates from conventional and inverse shoulder replacements. Results: The table summarises the number of shoulder arthroplasties inserted over the past 5 years. The proportion of inverse primary arthroplasties has risen from 16% to 33%.

However the complication rates have been noticeably higher for the Inverse shoulder arthroplasties with 2/44 (5%) not being completed at surgery and 5/44 (11%) requiring surgical revision subsequently. This experience mirrors that of other publications which will be summarised.

Conclusion: Inverse shoulder replacement is a good operation for patients over 70 with large and massive rotator cuff tears. For younger patients and other indications the complication rate may be unacceptably high and the “bail out” options at revision surgery are limited and challenging. The take home message is use this prosthesis with caution and you must counsel your patient before surgery about the serious complications which may occur.