Background: Revision of unstable reverse shoulder arthroplasty (RSA) remains a significant challenge. The purpose of this study was to determine the reliability of a new treatment-guiding classification for instability after RSA, to describe the clinical outcomes of patients stabilized operatively, and to identify those with higher risk of recurrence.
Methods: All patients undergoing revision for instability after RSA were identified at our institution. Demographic, clinical, radiographic, and intraoperative data were collected. A classification was developed using all identified causes of instability after RSA and allocating them to 1 of 3 defined treatment-guiding categories. Eight surgeons reviewed all data and applied the classification scheme to each case. Interobserver and intraobserver reliability was used to evaluate the classification scheme. Preoperative clinical outcomes were compared with final follow-up in stabilized shoulders.
Results: Forty-three revision cases in 34 patients met the inclusion for study. Five patients remained unstable after revision. Persistent instability most commonly occurred in persistent deltoid dysfunction and postoperative acromial fractures but also in 1 case of soft tissue impingement. Twenty-one patients remained stable at minimum 2 years of follow-up and had significant improvement of clinical outcome scores and range of motion. Reliability of the classification scheme showed substantial and almost perfect interobserver and intraobserver agreement among all the participants (κ = 0.699 and κ = 0.851, respectively).
Discussion: Instability after RSA can be successfully treated with revision surgery using the reliable treatment-guiding classification scheme presented herein. However, more understanding is needed for patients with greater risk of recurrent instability after revision surgery.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jse.2017.09.031 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Outcomes and Complications of Failed Anatomic Shoulder Arthroplasty Revised with Reverse Arthroplasty: A Systematic Review.
J Shoulder Elbow Surg
December 2024
Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Electronic address:
Background: Reverse shoulder arthroplasty (RSA) is an increasingly utilized option to address complications following anatomic total shoulder arthroplasty (TSA). This systematic review aims to identify the patient outcomes, complication rates, and re-revision rates following revision to a reverse shoulder replacement from a failed anatomic total shoulder arthroplasty.
Methods: MEDLINE, EMBASE, and CENTRAL were searched from inception until November 21, 2023 to identify studies reporting outcomes and/or complications for patients with a failed TSA revised to an RSA.
Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications.
Cureus
November 2024
Pulmonology and Critical Care, Government Medical College, Srinagar, Srinagar, IND.
Proximal humerus fractures are prevalent in older adults, particularly women, primarily due to osteoporosis and increased fall risk. These fractures often result from low-energy falls in elderly patients, while in younger individuals, they are more likely to occur with high-energy trauma, which may involve additional injuries to soft tissue and neurovascular structures. Proper anatomical understanding, including key structures and blood supply, is crucial for effective management and to prevent complications.
View Article and Find Full Text PDFLow Success Rate of Closed Reductions when Treating Dislocations after Reverse Shoulder Arthroplasty: A Study by the ASES Complications of RSA Multicenter Research Group.
J Shoulder Elbow Surg
November 2024
Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA.
Article Synopsis
- * A total of 2.1% of patients (n=138) experienced dislocations, primarily within the first 90 days post-surgery, with different treatment approaches for dislocation including closed reduction, open reduction, revision arthroplasty, or benign neglect.
- * Among those treated with closed reduction, only 31% were successfully resolved without further intervention, while many either required revision surgery or experienced recurrent dislocations, highlighting the complexity of managing these postoperative complications.
Introduction: This article presents a simultaneous operative technique, which allowed to successfully treat a Cuff Tear Arthropathy (CTA), instability and Levy-type III scapular spine fracture non-union with 90°-double plating, humerus-to-scapula grafting and simultaneous reverse shoulder arthroplasty.
Case Report: We present a 64year-old woman with previously known cuff arthropathy (2012/53yo). She fell in 2017 (58 years old with minor shoulder disability) before dislocating the shoulder in 2020 (60 years old) with evidence of a medial Levy-type III scapular spine fracture non-union and severe apprehension, unable to anterior elevate her arm more than 90°.
Managing Subscapularis in Shoulder arthroplasty.
J Clin Orthop Trauma
October 2024
Department of Trauma & Orthopaedics, Medway NHS Foundation Trust, UK.
Article Synopsis
- Managing the subscapularis is crucial in shoulder arthroplasty, with various techniques for release and repair (tenotomy, peel, lesser tuberosity osteotomy) showing similar outcomes based on clinical studies, though biomechanical studies lean towards favoring lesser tuberosity osteotomy.
- A subscapularis sparing approach offers early rehabilitation potential but requires more research to evaluate its long-term advantages.
- If subscapularis repair fails after anatomical shoulder replacement, it can lead to issues like pain and instability, with potential treatment options including revision repairs, tendon transfer, and the switch to reverse shoulder arthroplasty, noting that the effects of repair vary based on the design of the implant used.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!