Reverse polarity shoulder replacements are indicated in cases of gleno-humeral arthritis with the presence of rotator cuff muscle dysfunction. Despite some studies demonstrating early improvement in function and pain, limited information still exists regarding the durability and longer term outcomes of these prostheses. The reported complication rates have been reported to range from 0–68%. Post-operative clinical complication rates of three commonly used reverse polarity total shoulder replacements (Delta, Verso and Equinoxe) were evaluated against those mentioned in the literature to predict satisfactory outcome. A retrospective review of 54 patients (3.5F:1M) and 64 operations (27L:37R) between 2004–2011 was carried out. Post-operative complications were searched for through medical records, the local hospital database (BLuespearIT) and the Picture Archiving and Imaging System (PACS). All operations were performed by two experienced consultant-grade orthopaedic shoulder surgeons. The mean age at time of operation was 75.9 years (range 64–94). 33 Delta, 19 Equinoxe and 12 Verso prostheses were inserted. Three patients were excluded from the study due to insufficient information from medical records and radiography. Total complications were seen in 25 % of operated cases:- dislocation (6), fracture (4), deep infection (2), significant post-operative pain (1) and deltoid muscle dysfunction (3). Complications categorised according to prosthesis type were:- Delta (24%), Equinoxe (32%) and Verso (8%). Short to medium term complication rates using reverse polarity total shoulder replacements are higher than the majority of the current literature suggests. The Verso is associated with the least number of complications which may correlate with its minimally invasive approach.
Distension arthrography of the glenohumeral joint was adopted as a mainstream treatment for adhesive capsulitis before any randomised controlled trials were performed. Interpretation of the effectiveness of this procedure rests on data from cohort studies of which there are few of high quality. Papers reporting on the long-term results have either excluded diabetic patients or failed to report on patient orientated outcomes. We present a prospective cohort study of 51 patients with adhesive capsulitis of the shoulder who had a distension arthrogram performed by a single radiologist as a primary intervention. We included diabetic patients. Range of movement (ROM), Oxford shoulder score (OSS) and a visual analogue pain score (VAS) were recorded pre-procedure, at 2 days and 1 month. OSS and VAS were recorded again at a mean of 14 months post procedure (range 8–26 months). OSS improved from pre-procedure mean of 22.3 by 16.9 points at final follow up in September 2011 (p < 0.001) whilst VAS improved from a mean pre-procedure of 7.1 by −3.5 by September 2011 (p< 0.001). ROM improved with a mean increase of 39.3 degrees in flexion, 55.2 degrees in abduction and 19.5 degrees in external rotation by 1 month (p < 0.001 for all). The outcome in diabetic patients was the same as in non-diabetic patients. We conclude that distension arthrography is a safe and effective treatment for adhesive capsulitis.
