Reverse Shoulder Arthroplasty: How to Prevent Failure
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Increased use of primary RSA has led to reports of associated problems unique to the procedure. The most common complications include scapular notching, glenohumeral dislocation, mechanical baseplate failure, scapular fracture, loss of external rotation, nerve injury, and infection.
Inferior scapular notching is a well-documented complication that is observed on 16–96% of postoperative radiographs and has a potential impact on clinical outcomes. Inferior glenoid positioning, inferior tilt of the glenosphere, lateralization, eccentricity and enlargement of the glenosphere, and prosthetic overhang showed to be effective in preventing scapular conflict in a RSA. Improvement in primary fixation of the glenoid component reduced the failure rate of the glenoid component. Novel design of humeral components, such as short stem or stemless design, can facilitate prosthetic removal in the case of revision surgery. Finally, new methods of preoperative planning for management of glenoid bone loss such as 3D preoperative planning and patient-specific instrumentation are promising improvements in clinical outcomes and implant survivorship.
KeywordsReverse shoulder arthroplasty Failure Glenoid Notching Revision
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