Abstract
The Delta total shoulder replacement is a reversed, semi-constrained prosthesis and is recommended for the management of rotator cuff arthropathy and other difficult reconstructive shoulder problems. It was initially advised to use this prosthesis in patients older than 75. There were reports saying the complication rates of this prosthesis are high and patients' satisfaction and functional outcome is far from being satisfactory. In our study we wanted to evaluate results and complications of reverse shoulder arthroplasty in practice of single surgeon.
In our study we reviewed patients who had reverse shoulder arthroplasty performed between 2001 and 2009. We evaluated them clinically and radiologically. We measured functional outcome using Constant score, we used Oxford Shoulder score to measure patients' subjective outcome. We compared our results to pre-operative Oxford Shoulder score (unfortunately no pre-op constant score was done). X-rays were assessed by independent surgeon who was not involved in care of the patients.
Out of 36 reverse shoulder replacements performed by Mr. Sinha from 2001 to 2009 we managed to review in clinic 29 shoulders. 3 patients died from causes not related to surgery, 3 patients were too unwell to attend clinic, we lost 1 patient to follow up. Mean time from operation to follow up was 33 months (range 6 to 82 months). Average patients' age at time of surgery was 73,4 years (range: 44 to 90). Indications included rotator cuff arthropathy (86%), other indications were trauma (10%) and revision of failed hemiarthroplasty (4%). There were neither revisions nor infections in our group. There was 1 dislocation that occurred after operation, this was reduced under GA and never re-dislocated again. 12 patients (41%) were very pleased with result of surgery, 15 patients (52%) were satisfied and 2 patients said surgery did not meet their expectations. Mean Shoulder Oxford score improved from 20.8 (range 2 to 36) pre-operatively to 36.7 (range 20 to 48) during follow up. 3 patients had Oxford Shoulder score of 48 (maximum). Oxford shoulder score deteriorated in 2 cases (one in case when replacement was done to treat fracture). Post operative Constant score was 65.5. All patients but one declared overall improvement. 10 patients (34%) reported no pain at all. 5 patients who were 65 years old or younger at time of surgery did well and improved their shoulder function.
In our experience reverse geometry shoulder replacement is a very good solution for rotator cuff arthropathy. Results in proximal humeral fracture are worse, but the number of patients we had was small and our experience is limited. Mid term results are very satisfactory overall, even in younger and more demanding patients. The complications were rare and overall patients' satisfaction very high. We think more research needs to be done to asses long term results, especially in younger population.
