A Lädermann1,2,3, A J Schwitzguebel1, T B Edwards4, A Godeneche5, L Favard6, G Walch5, F Sirveaux7, P Boileau8, C Gerber9. 1. Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland. 2. Faculty of Medicine, University of Geneva, Geneva, Switzerland. 3. Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland. 4. Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, Texas, USA. 5. Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital, Lyon, France. 6. Service Orthopédie Traumatologie, CHU Trousseau, Tours, France. 7. Division of Orthopaedics and Trauma Surgery, Centre Chirurgical Émile-Gallé, Nancy, France. 8. Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet-University of Nice Sophia-Antipolis, Nice, France. 9. Department of Orthopaedics, University Hospital, Balgrist, Zurich, Switzerland.
Abstract
AIMS: The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. PATIENTS AND METHODS: We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. RESULTS: From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). CONCLUSION: When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461-469.
AIMS: The aim of this study was to report the outcomes of different treatment options for glenoid loosening following reverse shoulder arthroplasty (RSA) at a minimum follow-up of two years. PATIENTS AND METHODS: We retrospectively studied the records of 79 patients (19 men, 60 women; 84 shoulders) aged 70.4 years (21 to 87) treated for aseptic loosening of the glenosphere following RSA. Clinical evaluation included pre- and post-treatment active anterior elevation (AAE), external rotation, and Constant score. RESULTS: From the original cohort, 29 shoulders (35%) were treated conservatively, 27 shoulders (32%) were revised by revision of the glenosphere, and 28 shoulders (33%) were converted to hemiarthroplasty. At last follow-up, conservative treatment and glenoid revision significantly improved AAE, total Constant score, and pain, while hemiarthroplasty did not improve range of movement or clinical scores. Multivariable analysis confirmed that conservative treatment and glenoid revision achieved similar improvements in pain (glenoid revision vs conservative, beta 0.44; p = 0.834) but that outcomes were significantly worse following hemiarthroplasty (beta -5.00; p = 0.029). CONCLUSION: When possible, glenoid loosening after RSA should first be treated conservatively, then by glenosphere revision if necessary, and last by salvage hemiarthroplasty Cite this article: Bone Joint J 2019;101-B:461-469.
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