Ruben Dukan1, Mohammad Bahman2, Marc-Antoine Rousseau2, Patrick Boyer2. 1. Université Paris Diderot, Bichat Hospital, service d'orthopédie, Paris, France. Electronic address: ruben.dukan@gmail.com. 2. Université Paris Diderot, Bichat Hospital, service d'orthopédie, Paris, France.
Abstract
BACKGROUND: Reverse shoulder arthroplasties have progressed in recent decades to become the most popular type of arthroplasty. Short stems with metaphyseal fixation have been developed to preserve bone stock and facilitate possible revision. Accurate positioning of these implants can be challenging using the superolateral approach. OBJECTIVE: This study aimed to evaluate the clinical and radiologic results of reverse short-stem arthroplasties using a superolateral approach with a minimum of 2 years' follow-up. METHODS: Between January 2015 and December 2016, a total of 76 patients underwent reverse shoulder arthroplasty surgery (79 shoulders) using a short uncemented humeral stem for shoulder arthritis with irreparable rotator cuff tear. Arthroplasties for post-traumatic osteoarthritis were excluded. Functional outcomes were assessed using Constant Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and range of motion. Radiographic analysis was used to evaluate component loosening, implant position, and implant filling ratio. RESULTS: The mean age was 70.8 years. At a mean of 38.8-month follow-up, there were significant improvements in Constant score (44.2 to 87.9, P < .001), ASES score (36.2 to 84.3, P < .001), and VAS score (6.8 to 0.4, P < .001). Forward flexion improved from 89°to 131°(P < .001), and external rotation improved from 25° to 36°(P < .001). No evidence of periprosthetic loosening was visible. Mean varus of the humeral stem was 1°(±6°). The mean glenoidal inclination was 98°(±7°), which corresponds to a lower tilt of 8°. The average filling ratio was between 50% and 60% in both the metaphysis and the diaphysis. CONCLUSION: The clinical results obtained in this study were satisfying, with a significantly low complication rate. Hence, short-stem reverse shoulder arthroplasty using a superolateral approach, while taking particular care to protect the deltoid, remains our method of choice.
BACKGROUND: Reverse shoulder arthroplasties have progressed in recent decades to become the most popular type of arthroplasty. Short stems with metaphyseal fixation have been developed to preserve bone stock and facilitate possible revision. Accurate positioning of these implants can be challenging using the superolateral approach. OBJECTIVE: This study aimed to evaluate the clinical and radiologic results of reverse short-stem arthroplasties using a superolateral approach with a minimum of 2 years' follow-up. METHODS: Between January 2015 and December 2016, a total of 76 patients underwent reverse shoulder arthroplasty surgery (79 shoulders) using a short uncemented humeral stem for shoulder arthritis with irreparable rotator cuff tear. Arthroplasties for post-traumatic osteoarthritis were excluded. Functional outcomes were assessed using Constant Score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and range of motion. Radiographic analysis was used to evaluate component loosening, implant position, and implant filling ratio. RESULTS: The mean age was 70.8 years. At a mean of 38.8-month follow-up, there were significant improvements in Constant score (44.2 to 87.9, P < .001), ASES score (36.2 to 84.3, P < .001), and VAS score (6.8 to 0.4, P < .001). Forward flexion improved from 89°to 131°(P < .001), and external rotation improved from 25° to 36°(P < .001). No evidence of periprosthetic loosening was visible. Mean varus of the humeral stem was 1°(±6°). The mean glenoidal inclination was 98°(±7°), which corresponds to a lower tilt of 8°. The average filling ratio was between 50% and 60% in both the metaphysis and the diaphysis. CONCLUSION: The clinical results obtained in this study were satisfying, with a significantly low complication rate. Hence, short-stem reverse shoulder arthroplasty using a superolateral approach, while taking particular care to protect the deltoid, remains our method of choice.
Authors: Sarav S Shah; Alexander M Roche; Spencer W Sullivan; Benjamin T Gaal; Stewart Dalton; Arjun Sharma; Joseph J King; Brian M Grawe; Surena Namdari; Macy Lawler; Joshua Helmkamp; Grant E Garrigues; Thomas W Wright; Bradley S Schoch; Kyle Flik; Randall J Otto; Richard Jones; Andrew Jawa; Peter McCann; Joseph Abboud; Gabe Horneff; Glen Ross; Richard Friedman; Eric T Ricchetti; Douglas Boardman; Robert Z Tashjian; Lawrence V Gulotta Journal: JSES Int Date: 2020-09-10