RESULTS OF 30 REVERSE PROSTHESIS IMPLANTED FOR FAILURE OF HEMI OR TOTAL SHOULDER ARTHROPLASTY

Abstract

Aims: The revision of hemi or total arthroplasty represents a difficult challenge for a shoulder surgeon. The purpose of this study was to report the results of a retrospective series of 30 reverse prosthesis.

Materials and Methods: 17 patients were female, 13 were male; the mean age was 68 (45–84). 14 patients had at least 2 surgeries before the arthroplasty. Of the failed arthroplasties, 26 were hemiarthroplasties and 4 were total shoulder arthroplasties. The indication for the revision of hemiarthroplasty were: 10 migration of the tuberosities, 7 secondary rotator cuff tears, 5 were stiff, 2 glenoiditis,, one humeral loosening and one sepsis. The indication for the revision of total arthroplasty were 3 loosenning of the glenoïd component and 2 secondary rotator cuff tear with a superior ascension of the humeral head. The rotator cuff was always irreparable. We used mainly a deltopectoral approach. During the removing of the humeral component and the cement, 6 fractures of the diaphysis occurred treated by cerclage. A bone graft was used at the level of the glenoïd (3) and of the humerus (4). We implanted 19 Delta and 11 Arrow reverse prosthesis. The patients were reviewed clinically using the Constant score with a mean follow up 3 years (range 1–5 years).

Results: The Constant score improved from 20 (6–39) pre operatively to 55 (44–87) post operatively. Shoulder flexion increased from 45 (20–100) pre operatively to 100 degrees (90–160) post operatively. Pain was improved from 3/15 to 13,66/15 post operatively. The worse results were obtained for the patients who were multioperated before the first arthroplasty. Four patients were reoperated: 2 for dislocations and two for material dysfunction(glenosphere). 6 patients were disappointed, 18 were satisfied and 6 patients were very satisfied subjectively with the procedure. No difference in term of clinical results between Delta and Arrow except no glenoid notch occurred with Arrow prosthesis.

Discusssion and conclusion: After a failure of an hemi or total arthroplasty, if the cuff is no functional or no reparable, reverse prosthesis is currently the best salvage procedure. Bone glenoid stock and deltoid muscle are the limited factors. Surgical tips and tricks should be known before to do this difficult operation. Others procedures can be discussed: reconstruction of the coracoacromial arch, gleno-humeral arthrodesis, deltoïd flap or latissimus dorsi flap and others semi-contrained prosthesis. Patients who had pseudo-paralytic painfull shoulder, without stiffness after an arthroplasty with less than 2 previous operations represent our best results.