International Orthopaedics

, Volume 38, Issue 6, pp 1213–1218 | Cite as

Reverse shoulder arthroplasty with a short metaphyseal humeral stem

  • Ehud Atoun
  • Alexander Van Tongel
  • Nir Hous
  • Ali Narvani
  • Jai Relwani
  • Ruben Abraham
  • Ofer Levy
Original Paper

Abstract

Purpose

Reverse shoulder prostheses have been gaining popularity in recent years. A short metaphyseal stem design will allow bone stock preservation and minimize stem related complications. We examined the clinical and radiographic short-term outcome of a short metaphyseal stem reverse shoulder arthroplasty.

Methods

Thirty-one patients, with a mean follow-up of 36 months (24–52), were evaluated clinically with the Constant-Murley score, patient satisfaction and pain relief scores. The fixation of the glenoid and humeral components, subsidence and notching were evaluated on radiographs. The indications were cuff tear arthropathy (22), fracture sequelae (five) and rheumatoid arthritis (four).

Results

The average Constant score improved from 12.7 (range two to 31) pre-operatively to 56.2 (range 17–86) postoperatively. It rose from 13.5 to 58.3 in patients with Cuff arthropathy, from 15.8 to 62.0 in revision arthroplasty, from 10.2 to 47.4 in those with fracture sequelae, and from 11.5 to 55.3 in patients with rheumatoid arthritis. The overall mean patient satisfaction score improved from 2.4/10 to 8.5/10 and mean pain score improved from 0.8/15 to 12.5/15. We found an overall improvement in active forward flexion from 46.8 to 128.5° and from 41.6 to 116.5° in abduction. No humeral loosening or subsidence was observed. Two cases of grade 1–2 glenoid notching were reported. Overall there were three intra-operative fractures that did not affect the operation and healed without affecting the good results. There were five late traumatic periprosthetic fractures, only one of them required a revision surgery to a stemmed implant and the rest healed without surgery. There were two early dislocations that had to be revised.

Conclusions

The clinical and radiographic evaluation of a bone preserving metaphyseal humeral component in reverse shoulder arthroplasty is promising, with good clinical results, no signs of loosening or subsidence.

References

  1. 1.
    Grammont TP, Laffay J, Deries X (1987) Concept study and realization of a new total shoulder prosthesis. Rhumatologie 39:407–418Google Scholar
  2. 2.
    Terrier A, Reist A, Merlini F, Farron A (2008) Simulated joint and muscle forces in reversed and anatomic shoulder prostheses. J Bone Joint Surg (Br) 90:751–756. doi:10.1302/0301-620X.90B6.19708 CrossRefGoogle Scholar
  3. 3.
    Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 14:147S–161S. doi:10.1016/j.jse.2004.10.006 PubMedCrossRefGoogle Scholar
  4. 4.
    Farshad M, Gerber C (2010) Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop 34:1075–1082. doi:10.1007/s00264-010-1125-2 PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Werner CM, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 87:1476–1486. doi:10.2106/JBJS.D.02342 PubMedCrossRefGoogle Scholar
  6. 6.
    Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D (2004) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg (Br) 86:388–395CrossRefGoogle Scholar
  7. 7.
    Levy JC, Virani N, Pupello D, Frankle M (2007) Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg (Br) 89:189–195. doi:10.1302/0301-620X.89B2.18161 CrossRefGoogle Scholar
  8. 8.
    Stechel A, Fuhrmann U, Irlenbusch L, Rott O, Irlenbusch U (2010) Reversed shoulder arthroplasty in cuff tear arthritis, fracture sequelae, and revision arthroplasty. Acta Orthop 81:367–372. doi:10.3109/17453674.2010.487242 PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Zumstein MA, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20:146–157. doi:10.1016/j.jse.2010.08.001 PubMedCrossRefGoogle Scholar
  10. 10.
    Levy O, Copeland SA (2004) Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder. J Shoulder Elbow Surg 13:266–271. doi:10.1016/S1058274604000229 PubMedCrossRefGoogle Scholar
  11. 11.
    Wirth MA, Rockwood CA Jr (1996) Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am 78:603–616PubMedGoogle Scholar
  12. 12.
    Wall B, Nove-Josserand L, O’Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89:1476–1485. doi:10.2106/JBJS.F.00666 PubMedCrossRefGoogle Scholar
  13. 13.
    Andersen JR, Williams CD, Cain R, Mighell M, Frankle M (2013) Surgically treated humeral shaft fractures following shoulder arthroplasty. J Bone Joint Surg Am 95:9–18. doi:10.2106/JBJS.K.00863 PubMedCrossRefGoogle Scholar
  14. 14.
    Levy O, Copeland SA (2001) Cementless surface replacement arthroplasty of the shoulder. 5- to 10-year results with the Copeland mark-2 prosthesis. J Bone Joint Surg (Br) 83:213–221CrossRefGoogle Scholar
  15. 15.
    Mackenzie D (1993) The antero-superior exposure of a total shoulder replacement. Orthop Traumatol 2:71–77CrossRefGoogle Scholar
  16. 16.
    Matsen F (2005) Commentary and perspective on “The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients”. J Bone Joint Surg Am 87:1697CrossRefGoogle Scholar
  17. 17.
    Melis B, DeFranco M, Ladermann A, Mole D, Favard L, Nerot C, Maynou C, Walch G (2011) An evaluation of the radiological changes around the Grammont reverse geometry shoulder arthroplasty after eight to 12 years. J Bone Joint Surg (Br) 93:1240–1246. doi:10.1302/0301-620X.93B9.25926 CrossRefGoogle Scholar
  18. 18.
    Bohsali KI, Wirth MA (2009) Fractures of the Proximal Humerus. In: Rockwood CA, Matsen FA III, Wirth MA, Lippitt SB (eds) The shoulder. Saunders, Philadelphia, an imprint of Elsevier IncGoogle Scholar
  19. 19.
    Kannus P, Palvanen M, Niemi S, Parkkari J, Jarvinen M, Vuori I (2000) Osteoporotic fractures of the proximal humerus in elderly Finnish persons: sharp increase in 1970–1998 and alarming projections for the new millennium. Acta Orthop Scand 71:465–470. doi:10.1080/000164700317381144 PubMedCrossRefGoogle Scholar
  20. 20.
    Palvanen M, Kannus P, Parkkari J, Pitkajarvi T, Pasanen M, Vuori I, Jarvinen M (2000) The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls. Osteoporos Int 11:822–831PubMedCrossRefGoogle Scholar
  21. 21.
    Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: A review. Injury 37:691–697. doi:10.1016/j.injury.2006.04.130 PubMedCrossRefGoogle Scholar
  22. 22.
    Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371. doi:10.1080/000164701753542023 PubMedCrossRefGoogle Scholar
  23. 23.
    Bohsali KI, Wirth MA, Rockwood CA Jr (2006) Complications of total shoulder arthroplasty. J Bone Joint Surg Am 88:2279–2292. doi:10.2106/JBJS.F.00125 PubMedCrossRefGoogle Scholar
  24. 24.
    Cameron B, Iannotti JP (1999) Periprosthetic fractures of the humerus and scapula: management and prevention. Orthop Clin North Am 30:305–318PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ehud Atoun
    • 1
  • Alexander Van Tongel
    • 2
  • Nir Hous
    • 2
  • Ali Narvani
    • 2
  • Jai Relwani
    • 2
  • Ruben Abraham
    • 2
  • Ofer Levy
    • 2
  1. 1.Orthopaedic Department, Faculty of Health SciencesBen-Gurion University, Barzilai Medical Center CampusAshkelonIsrael
  2. 2.Reading Shoulder UnitRoyal Berkshire HospitalReadingUK

Personalised recommendations