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.

Introduction: Shoulder arthroplasty is generally a successful procedure. However, in a small percentage excessive pain or limitation of motion, does occur. We examine the role of arthroscopy in the diagnosis and treatment of these patients.

Methods and Results: Between 1995–2000, 29 patients who had excessive pain or limitation of motion following arthroplasty underwent arthroscopy. Time between procedures was 37.3 months (range 4–95).

Impingement syndrome confirmed and successfully treated by ASD in 10, a rotator cuff tear in 3. Loose bodies removed in 1. Arthroscopic washout was performed in 1 patient for acute septic joint. 6 of 7 with capsular fibrosis underwent a successful arthroscopic capsular release. Loose or worn components were found in 4, a florid synovitis in 1, loose cement in another and in 1 no abnormality could be found.

Discussion: Arthroscopy is a useful tool for diagnosis and treatment of painful or stiff shoulder arthroplasty. However, it leads to a number of technical difficulties. Orientation within the joint is often hindered as the reflection from the prosthesis makes it difficult to differentiate between the real and mirror images of the tissues and arthroscopic instruments. Access is often compromised in stiff shoulders.

Conclusion: Arthroscopy following shoulder arthroplasty is useful for the diagnosis and treatment of pain and loss of motion in selected patients, but can be technically difficult. Diagnostic arthroscopy following shoulder arthroplasty should be considered for patients suffering from pain in whom no cause could be found using less invasive investigations.

The aim of this studdy was to examine the effect of cementless surface replacement shoulder arthroplasty (CSRA) on proximal humeral anatomy in eroded shoulder joints.

AP radiographs of 39 shoulders in 37 patients that underwent CSRA for arthritis were examined for geometry of the glenohumeral joint with correction for the magnification of our apparatus. Thirty-two were hemiarthroplasties and seven were total shoulder replacements (TSR). Average age was 70 years (range: 29–88 years). Mean clinical and radiological follow-up was 38 month (range: 24–72 months) and 16 months (range: 10–65 months) respectively. We measured reliable values on the proximal humerus and the lateral glenohumeral offset (LGHO) relative to the coracoid base. Preoperative and last follow-up Constant scores were recorded.

Based on anatomical data with respect to humeral head radius there was a mean 6mm preoperative loss in LGHO (95% CI 3.6–8.8, p< 0.01). The mean value of 53mm increased postoperatively to 59mm and was 57mm at last follow-up. The mean changes were an increase of 6mm (95% CI 4.4–8.5, p< 0.01) and then a decrease of 2mm (95% CI 0.1–5.4, p=0.04) respectively. The lever arm, measured from the greater tuberosity to the centre of instant rotation, increased a mean 5mm post-operatively (95% CI 3.8–6.4, p< 0.01) with no significant fall at last follow-up. Humeral head size and medial offset relative to shaft width increased by 13% and 30% respectively. The humeral head centre moved superiorly relative to the glenoid a mean 2mm after operation (95% CI −0.2–3.5, p=0.08) and a further 1mm at last follow-up (95% CI −0.1–3.0, p=0.07). Forward flexion and abduction improved from 66′ and 58′ preoperatively to 124′ and 112′ postoperatively, with age/ sex-adjusted Constant scores increasing by 53 (95% CI 43.0–64.4, p< 0.01) from a mean 25 preoperatively to 79 at last follow-up.

For hemiarthroplasty the LGHO increased by 9% and for TSR by 24%, with greater increases in flexion and abduction in the latter group.

The Copeland CSRA is centred on the native humeral neck for head version and offset. This preserves maximal bone stock and avoids the need for modularity which some modern stemmed prostheses use to reconcile differences between proximal shaft and humeral head anatomy. The inherent limitation is the requirement for preservation of sufficient humeral head to permit resurfacing. In this group with fairly marked degrees of joint erosion the CSRA, using autogenous bone graft and prostheses of variable width, achieved statistically and clinically significant increases in the lever arm. The improved biomechanics and soft tissue tension correlated to a good clinical outcome with no evidence of significant early subsidence.

We present the short- and medium-term clinical results of thermal shrinkage in selected groups of patients with multidirectional or capsular stretch-type instability. We treated 56 patients (61 shoulders) by laser-assisted capsular shrinkage (LACS) and 34 patients (38 shoulders) by radiofrequency (RF) capsular shrinkage. The two groups were followed for mean periods of 40 months and 23 months, respectively.

In the LACS group the mean Walch-Duplay score improved to 90 points 18 months after the operation, but then declined to a plateau of about 80 points; 59% of patients considered their shoulders to be ‘much better’ or ‘better’ but there was a failure rate of 36.1%. For the RF group the mean Walch-Duplay and Constant scores were 80 points at the various follow-up times; 76.3% of patients considered their shoulder to be ‘much better’ or ‘better’. RF failed in nine shoulders (23.7%). These results match some clinical series of patients with multidirectional instability, undergoing open inferior capsular shift, with a similar rate of failure. We believe that the minimal morbidity involved makes thermal shrinkage a viable alternative to open capsular shift in this difficult group of patients.