Reverse total shoulder arthroplasty (RTSA) provides reconstructive options in patients previously not candidates for total shoulder arthroplasty (TSA) or who have failed previous anatomic TSA. Revision from anatomic TSA to RTSA previously required removal of all components, a difficult and extensive procedure. Modular humeral components permit conversion from anatomic TSA to RTSA without removal of well-fixed humeral components.
Our purpose is to present a case series of patients treated for the unique and not previously reported complication of humeral tray-taper failure following modular RTSA. Challenges in diagnosis and treatment are described, including the use of dynamic fluoroscopy and manufacturer-specific instruments for component revision.
Five patients with a total of six humeral tray-taper failures were identified from 300 patients with first-generation (titanium) humeral trays over a 7-year period. Dynamic fluoroscopic evaluation aided in diagnosis in a majority of the cases. All cases have been revised to second-generation (cobalt chrome) humeral trays.
Average follow-up was 22 ± 23 months (range 3–60 months). One individual required a second revision for the same complication, but otherwise, no additional procedures were required. Symptom relief was obtained in all patients.
This case series illustrates a previously unpublished complication of humeral tray-taper junction failure following modular RTSA. Clinical and radiographic diagnosis is challenging; however, dynamic fluoroscopic evaluation permits identification of the component failure, and revision surgery results in good outcomes. We must, however, continue to evaluate what activities are recommend for patients following shoulder arthroplasty, specifically reverse total shoulder arthroplasty.
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Conflict of Interest
Lucas S. McDonald, MD, and Christopher Chin, BA, have declared that they have no conflict of interest. Joshua S. Dines, MD, reports personal fees from Arthrex, outside the work; family member receives royalties from Biomet. Russell F. Warren, MD, reports personal fees from Biomet and other fees from Ivy Sports Medicine and Orthonet and receives royalties for Shoulder Arthroplasty patent, outside the work. David M. Dines, MD, reports personal fees from Biomet and receives royalties for a Shoulder Arthroplasty patent and is a board member of Journal of Shoulder and Elbow Surgery, outside the work.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was waived from all patients for being included in the study.
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Work performed at Hospital for Special Surgery, New York, New York.
Level of Evidence: Level IV: Therapeutic Study.
Electronic supplementary material
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Dynamic fluoroscopic examination of the left shoulder reverse total shoulder arthroplasty demonstrating humeral tray-taper failure. This is clearly identified as the radiolucent space between the humeral tray and the humeral stem as the arm is taken through a range of motion (MOV 46764 kb)
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McDonald, L.S., Dines, J.S., Chin, C. et al. Humeral Tray-Taper Failure in Modular Reverse Total Shoulder Arthroplasty. HSS Jrnl 12, 8–12 (2016) doi:10.1007/s11420-015-9470-8
- reverse total shoulder arthroplasty
- humeral tray-taper failure
- modular components
- revision surgery