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Reverse shoulder arthroplasty with a cementless short metaphyseal humeral prosthesis without a stem: survivorship, early to mid-term clinical and radiological outcomes in a prospective study from an independent centre

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Abstract

Introduction

The use of reverse total shoulder arthroplasty has increased for the management of cuff-deficient glenohumeral joint arthritis and fractures. With bone preservation being a major target in reverse shoulder arthroplasty, metaphyseal humeral components without a stem were developed. The aim of this study is to present the survivorship, functional and radiological outcomes of a novel short metaphyseal prosthesis without a diaphyseal stem from an independent centre.

Methods

Clinical function and radiological features of patients undergoing stemless reverse shoulder arthroplasty were prospectively recorded. Patients’ demographics, indications for surgery, complications, functional and radiological assessment at the final follow-up as well as survivorship with the end point of revision for any reason were recorded.

Results

Between 2009 and 2016, 36 patients received 37 reverse shoulder arthroplasties with the stemless Verso prosthesis. Mean age of the patients was 76.9 years. The most common indication for surgery was cuff tear arthropathy. Mean follow-up was 3 years (range 1–7 years). Oxford shoulder score improved from an average of 11 pre-operatively (range 2–19) to 44 post-operatively (range 29–48) (p < 0.0001). There was one case of a deep post-operative infection that needed washout, liner exchange with retention of the prosthesis. Radiographic analysis showed no lucencies, or stress shielding around the humeral or glenoid components. Constant score at the final follow-up was on average 63 (range 35–86). Activities of daily living with requirement for internal and external rotation score (ADLEIR) was on average 12 pre-operatively (range 0–27) and 31 post-operatively (range 18–36) (p < 0.0001). There was 100% survivorship of the prosthesis in this early to mid-term study.

Conclusion

This early to mid-term prospective study demonstrates excellent survivorship and radiological results of the Verso reverse shoulder replacement. It needs a simple reproducible technique, and the results have been replicated at an independent centre. This study underlines its survivorship in the early to mid-term and confirms lower incidence of complications such as instability, notching, loosening and the need for revision surgery. Most importantly, it conserves the humeral bone stock for revision arthroplasties in the future. Our results are similar to those of the currently published literature.

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References

  1. 1.

    Cuff D, Pupello D, Virani N, Levy J, Frankle M (2008) Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 90:1244–1251. https://doi.org/10.2106/JBJS.G.00775

  2. 2.

    Nam D, Kepler CK, Neviaser AS, Jones KJ, Wright TM, Craig EV et al (2010) Reverse total shoulder arthroplasty: current concepts, results, and component wear analysis. J Bone Joint Surg Am 92(Suppl 2):23–35. https://doi.org/10.2106/JBJS.J.00769

  3. 3.

    Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M (2005) 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 87:1697–1705. https://doi.org/10.2106/jbjs.d.02813

  4. 4.

    Matsen FA III, Boileau P, Walch G, Gerber C, Bicknell RT (2007) The reverse total shoulder arthroplasty. J Bone Joint Surg Am 89:660–667

  5. 5.

    Sanchez-Sotelo J (2009) Reverse total shoulder arthroplasty. Clin Anat 22:172–182. https://doi.org/10.1002/ca.20736

  6. 6.

    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. https://doi.org/10.1016/j.jse.2010.08.001

  7. 7.

    Nicholson G, Strauss E, Sherman S (2011) Scapular notching: recognition and strategies to minimize clinical impact. Clin Orthop Relat Res 469(9):2521–2530

  8. 8.

    Gerber C, Pennington SD, Lingenfelter EJ, Sukthankar A (2007) Reverse Delta-III total shoulder replacement combined with latissimus dorsi transfer. A preliminary report. J Bone Joint Surg Am 89:940–947. https://doi.org/10.2106/JBJS.F.00955

  9. 9.

    Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G (2006) Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 88:1742–1747. https://doi.org/10.2106/JBJS.E.00851

  10. 10.

    Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15:527–540. https://doi.org/10.1016/j.jse.2006.01.003

  11. 11.

    Levy J, Frankle M, Mighell M, Pupello D (2007) The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am 89:292–300. https://doi.org/10.2106/JBJS.E.01310

  12. 12.

    Levy O, Narvani A, Hous N, Abraham R, Relwani J, Pradhan R, Bruguera J, Sforza G, Atoun E (2016) Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study. J Shoulder Elbow Surg 25:1362–1370

  13. 13.

    Atoun E, Van Tongel A, Hous N, Narvani A, Relwani J, Abraham R et al (2014) Reverse shoulder arthroplasty with a short metaphyseal humeral stem. Int Orthop 38:1213–1218. https://doi.org/10.1007/s00264-014-2328-8

  14. 14.

    Ballas R, Béguin L (2013) Results of a stemless reverse shoulder prosthesis at more than 58 months mean without loosening. J Shoulder Elbow Surg 22:e1–e6. https://doi.org/10.1016/j.jse.2012.12.005

  15. 15.

    Kadum B, Mukka S, Englund E, Sayed-Noor A, Sjödén G (2014) Clinical and radiological outcome of the total evolutive shoulder system (TESS(R)) reverse shoulder arthroplasty: a prospective comparative non-randomised study. Int Orthop 38:1001–1006. https://doi.org/10.1007/s00264-013-2277-7

  16. 16.

    Teissier P, Teissier J, Kouyoumdjian P, Asencio G (2015) The TESS reverse shoulder arthroplasty without a stem in the treatment of cuff-deficient shoulder conditions: clinical and radiographic results. J Shoulder Elbow Surg 24:45–51. https://doi.org/10.1016/j.jse.2014.04.005

  17. 17.

    Levigne C, Boileau P, Favard L, Garaud P, Mole D, Sirveaux F et al (2008) Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg 17:925–935. https://doi.org/10.1016/j.jse.2008.02.010

  18. 18.

    Nyffeler RW, Werner CM, Gerber C (2005) Biomechanical relevance of glenoid component positioning in the reverse Delta III total shoulder prosthesis. J Shoulder Elbow Surg 14:524–528. https://doi.org/10.1016/j.jse.2004.09.010

  19. 19.

    Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J, Cofield RH (2017) Complications in reverse shoulder arthroplasty. EFORT Open Rev 1(3):72–80. https://doi.org/10.1302/2058-5241.1.160003

  20. 20.

    Katz D, Valenti P, Kany J, Elkholti K, Werthel JD (2016) Does lateralisation of the centre of rotation in reverse shoulder arthroplasty avoid scapular notching? Clinical and radiological review of one hundred and forty cases with forty five months of follow up. Int Orthop 40(1):99–108. https://doi.org/10.1007/s00264-015-2976-3

  21. 21.

    Mollon B, Mahure SA, Roche CP, Zuckerman JD (2017) Impact of scapular notching on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 476 shoulders. J Shoulder Elbow Surg 26(7):1253–1261. https://doi.org/10.1016/j.jse.2016.11.043

  22. 22.

    Boileau P, Watkinson DJ, Hatzidakis AM, Balg F (2005) Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 14:147S–161S. https://doi.org/10.1016/j.jse.2004.10.006

  23. 23.

    Boulahia A, Edwards TB, Walch G, Baratta RV (2002) Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. Orthopedics 25:129–133

  24. 24.

    De Buttet A, Bouchon Y, Capon D, Delfosse J (1997) Grammont shoulder arthroplasty for osteoarthritis with massive rotator cuff tears: report of 71 cases. J Shoulder Elbow Surg 6:197

  25. 25.

    De Wilde L, Mombert M, Van Petegem P, Verdonk R (2001) Revision of shoulder replacement with a reversed shoulder prosthesis (Delta III): report of five cases. Acta Orthop Belg 67:348–353

  26. 26.

    De Wilde LF, Van Ovost E, Uyttendaele D, Verdonk R (2002) Results of an inverted shoulder prosthesis after resection for tumor of the proximal humerus. Rev Chir Orthop Reparatrice Appar Mot 88:373–378

  27. 27.

    Favard L, Lautmann S, Sirveaux F, Oudet D, Kerjean Y, Huguet D (2001) Hemi arthroplasty versus reverse arthroplasty in the treatment of osteoarthritis with massive rotator cuff tear. In: Walch G, Boileau P, Mole D (eds) Shoulder prosthesis: two to ten year follow-up. Sauramps Medical, Montpellier, pp 261–268

  28. 28.

    Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D (2011) Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res 469:2469–2475. https://doi.org/10.1007/s11999-011-1833-y

  29. 29.

    Lévigne C, Garret J, Boileau P, Alami G, Favard L, Walch G (2011) Scapular notching in reverse shoulder arthroplasty: is it important to avoid it and how? Clin Orthop Relat Res 469:2512–2520. https://doi.org/10.1007/s11999-010-1695-8

  30. 30.

    Nyffeler RW, Werner CM, Simmen BR, Gerber C (2004) Analysis of a retrieved delta III total shoulder prosthesis. J Bone Joint Surg Br 86:1187–1191. https://doi.org/10.1302/0301-620X.86B8.15228

  31. 31.

    Rittmeister M, Kerschbaumer F (2001) Grammont reverse total shoulder arthroplasty in patients with rheumatoid arthritis and nonreconstructible rotator cuff lesions. J Shoulder Elbow Surg 10:17–22

  32. 32.

    Sirveaux F, Favard L, Oudet D, Huguet D, Lautmann S (2001) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive and non repairable cuff rupture. In: Walch G, Boileau P, Mole D (eds) Shoulder prosthesis: two to ten year follow-up. Sauramps Medical, Montpellier, pp 247–252

  33. 33.

    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 86:388–395. https://doi.org/10.1302/0301-620X.86B3.14024

  34. 34.

    Valenti P, Boutens D, Nerot C (2001) Delta 3 reversed prosthesis for arthritis with massive rotator cuff tear: long term results (> 5 years). In: Walch G, Boileau P, Mole D (eds) Shoulder prosthesis: two to ten year follow-up. Sauramps Medical, Montpellier, pp 253–259

  35. 35.

    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. https://doi.org/10.2106/JBJS.D.02342

  36. 36.

    Delloye C, Joris D, Colette A, Eudier A, Dubuc JE (2002) Mechanical complications of total shoulder inverted prosthesis. Rev Chir Orthop Reparatrice Appar Mot 88:410–414

  37. 37.

    Cuff DJ, Virani NA, Levy J, Frankle MA, Derasari A, Hines B et al (2008) The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and post-operative antibiotics. J Bone Joint Surg Br 90:336–342. https://doi.org/10.1302/0301-620X.90B3

  38. 38.

    Hopkins AR, Hansen UN (2009) Primary stability in reversed-anatomy glenoid components. Proc Inst Mech Eng 223:805–812. https://doi.org/10.1243/09544119JEIM557

  39. 39.

    Melis B, DeFranco M, Lädermann A, Molé D, Favard L, Nérot C et al (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. https://doi.org/10.1302/0301-620X.93B9.25926

  40. 40.

    Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM (2010) Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 19:1115–1120. https://doi.org/10.1016/j.jse.2010.02.009

  41. 41.

    Boileau P (2016) Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res 102(1 Suppl):S33–S43. https://doi.org/10.1016/j.otsr.2015.06.031

  42. 42.

    Gohlke F, Rolf O (2007) Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the transhumeral approach: method incorporating a pectoralis-major-pedicled bone window. Oper Orthop Traumatol 19:185–208

  43. 43.

    Micheloni GM, Salmaso G, Berti M, Bortolato S, Zecchinato G, Momoli A et al (2019) Cementless metaphyseal reverse shoulder arthroplasty: our preliminary experience. Acta Biomed. 90(suppl 1):47–53. https://doi.org/10.23750/abm.v90i1-S.8064

  44. 44.

    Karlse AT, Bhatia DN, De Wilde LF (2008) Prosthetic component relationship of the reverse Delta III total shoulder prosthesis in the transverse plane of the body. J Shoulder Elbow Surg 17:602–607. https://doi.org/10.1016/j.jse.2008.02.005

  45. 45.

    Day JS, MacDonald DW, Olsen M, Getz C, Williams GR, Kurtz SM (2012) Polyethylene wear in retrieved reverse total shoulder components. J Shoulder Elbow Surg 21:667–674. https://doi.org/10.1016/j.jse.2011.03.012

  46. 46.

    Nam D, Kepler CK, Nho SJ, Craig EV, Warren RF, Wright TM (2010) Observations on retrieved humeral polyethylene components from reverse total shoulder arthroplasty. J Shoulder Elbow Surg 19:1003–1012. https://doi.org/10.1016/j.jse.2010.05.014

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Correspondence to Siddharth Virani.

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Leonidou, A., Virani, S., Buckle, C. et al. Reverse shoulder arthroplasty with a cementless short metaphyseal humeral prosthesis without a stem: survivorship, early to mid-term clinical and radiological outcomes in a prospective study from an independent centre. Eur J Orthop Surg Traumatol 30, 89–96 (2020). https://doi.org/10.1007/s00590-019-02531-2

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Keywords

  • Reverse shoulder replacement
  • Stemless
  • Uncemented
  • Clinical and radiological results
  • Constant score