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Dislocation after reverse total shoulder arthroplasty using contemporary medialized modular systems. Can we still consider it such a frequent complication?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Improvement in reverse total shoulder arthroplasty (RTSA) prosthesis and technique has reduced the initially high complication and revision rates associated with this implant. However, instability continues to be a leading cause of reoperation after RTSA, being related in previous studies with medialized designs. The aim of this study was to determine the dislocation rate with the employment of two medialized modular systems of RTSA in our institution.

Materials and methods

A retrospective review of two different modular systems of RTSA (SMR Modular Shoulder System and Delta XTEND Reverse Shoulder) was performed between 2009 and 2017 with a minimum 3-year follow-up. Baseline demographic, clinical (Constant, ASES and ROM), and radiographic data were collected. Characteristics of postoperative instability cases were also evaluated.

Results

237 primary RTSA (41% SMR/59% Delta) and 34 revision RTSA (44% SMR/56% Delta) with a mean follow-up of 75.6 ± 5.2 months (79.2 SMR/86.3 Delta, p = .586) were included in the present study. Indications for primary RTSA were osteoarthritis, rotator cuff tear arthropathy and massive irreparable rotator cuff tear (64%), acute fracture (32%), and fracture sequelae (4%). Subscapularis tendon was always repaired in degenerative pathology and tuberosities reattached in traumatic cases. The mean age of the global series was 76.5 ± 5.3 years (75.8 SMR/78.6 Delta, p = .104) with a mean Constant/ASES score at final follow-up of 68.5 ± 4.3/72.9 ± 20.3 (71/68 SMR and 69/74 Delta, p = .653 and .642). Only 2 patients (one acute fracture and one fracture sequelae) suffered an early postoperative anterior dislocation (before 3 months) which represents a rate of .84% in primary cases and .73% including revision surgery. Closed reduction manoeuvres were not successful, and both patients required revision surgery. At the end follow-up, both were stable and had no further dislocations.

Conclusion

The dislocation rate after RTSA with the employment of two contemporary modular systems with a medialized centre of rotation is extremely low, especially when compared with the previously published series with the original Grammont design. Acute fracture and fracture sequelae were the main diagnoses associated with this instability. The reasons for the low dislocation rate are multifactorial, but the improvement in the baseplate position according to the more recent standards of “ideal position” and technical aspects such as subscapularis repair or tuberosity reattachment in fractures probably play an important role in this aspect.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Shoulder and Elbow Unit, Department of Orthopedic and Trauma Surgery, Hospital Clínico San Carlos, C/Martín Lagos, s/n., 28040, Madrid, Spain

    Carlos Garcia-Fernandez, Yaiza Lopiz, Camilla Arvinius, Virginia Ponz, Borja Alcobía-Diaz, Pablo Checa, Maria Galán-Olleros & Fernando Marco

  2. Department of Surgery, Facultad de Medicina, Universidad Complutense, Madrid, Spain

    Yaiza Lopiz & Fernando Marco

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  1. Carlos Garcia-Fernandez
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Contributions

This manuscript has been read and approved by all authors, and we ensure that the manuscript represents an honest work. CG-F: Author responsible, YL: Writing—Review and Editing, CA: Investigation, VP: Writing—Original Draft, BA-D: Resources, Formal Analysis, MG-O: Writing—Original Draft, FM: Supervision.

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Correspondence to Carlos Garcia-Fernandez.

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Institutional review board approval for this study was received from the Ethics Committee for Clinical Research (CEIC) from Hospital Clínico San Carlos (Madrid, Spain) (C.I. 20/779-E).

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Garcia-Fernandez, C., Lopiz, Y., Arvinius, C. et al. Dislocation after reverse total shoulder arthroplasty using contemporary medialized modular systems. Can we still consider it such a frequent complication?. Eur J Orthop Surg Traumatol 32, 1525–1534 (2022). https://doi.org/10.1007/s00590-021-03131-9

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