Reverse polarity total shoulder arthroplasty (RTSA) has gained popularity over recent years for the treatment of the painful cuff deficient shoulder. Although proposed over 20 years ago and despite good clinical outcomes the RTSA has struggled to gain popularity due to reported high levels of complications. One such complication is post-operative instability with frequencies of up to 30% (De Wilde 2002). The Bayley-Walker RTSA was designed specifically for patients with difficult reconstruction problems in whom an unconstrained prosthesis would not offer sufficient stability. It is a reverse anatomy fixed fulcrum constrained prosthesis. The glenoid component has a long HA-coated tapered helical screw, with large pitch and depth, fixation is augmented by a grooved HA coated glenoid plate. The purpose of this study was to review the clinical experience from The Royal National Orthopaedic Hospital Stanmore and to ascertain the rate of glenoid component loosening. We also carried out a radiographic review to correlate loosening with patterns of lucency on post-operative radiographs. One hundred and five B-W TSRs in 103 patients were included, 24% of which were performed as revision of previous failed arthroplasty. In total, 8/105 glenoids required revision. Of those eight patients, two were cases of septic loosening. Of all nine specified areas of glenoid, tip lucency on x-ray appeared to be most strongly associated with need for glenoid revision. 5/9 cases with tip lucency progressed to loosening of the glenoid. Where tip lucency was not seen, 93/96 glenoid components remained secure, giving tip lucency a negative predictive value of 97%. Excluding the two infected cases, the glenoid remained secure in 97/103 patients undergoing BW-TSR with follow-up up to 13 years. The BW-TSR is a satisfactory and durable solution to the cuff-deficient shoulder in variety of challenging groups including younger patients and as a salvage procedure following failed, cuff-deficient arthroplasty.
The Stanmore Percentage of Normal Shoulder Assessment (SPONSA) is a simple, fast and reproducible measure of the subjective state of a shoulder. It has been invaluable in our busy clinical practice. This study validates the SPONSA score against the Oxford Shoulder and Constant score and demonstrates a greater sensitivity to change. The SPONSA involves defining the concept of ‘normality’ in a shoulder and then asking patients to express the current state of their shoulder as a percentage of normal. The score uses a specific script which is read exactly as typed. The SPONSA, Oxford Shoulder and Constant scores were measured by an independent observer in 61 consecutive patients undergoing treatment for shoulder conditions in our unit. Scores were recorded at 2-6 weeks before admission, immediately before intervention, and between 3-6 months post-intervention. The time taken to measure each score was recorded.Introduction
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