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Current Reviews in Musculoskeletal Medicine

Erschienen in:

01.02.2020 | Reverse Shoulder Arthroplasty (C Chambers and E Craig, Section Editors)

Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

verfasst von: Alexander R. Markes, Edward Cheung, C. Benjamin Ma

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 1/2020

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Abstract

Purpose of Review

The most common complications warranting revision consideration in reverse shoulder arthroplasty (RSA) include instability and its associated causes: infection, periprosthetic fracture, and glenoid baseplate loosening. Management of complications can be challenging and the nuances of treatment are still being elucidated. The focus of this paper is to review the treatment of the failed RSA and discuss evidence-based recommendations for revision.

Recent Findings

The most common complications requiring revision RSA are instability and infection. The causes for instability can be subdivided into three main subcategories: loss of compression, loss of containment, and impingement. Loss of compression is further broken down into 6 subcategories revolving around abnormal prosthesis positioning, undersized prostheses, or intrinsic soft-tissue tension loss leading to instability. Periprosthetic infection can also lead to instability, yet the most appropriate management for infected RSA remains controversial.

Summary

Restoring stability by maximizing deltoid and soft tissue tension while avoiding impingement revolves around three basic methods: (1) lateralizing and/or upsizing the glenosphere to an inferior position on the glenoid, (2) use of a more constrained polyethylene insert, and (3) distalizing the humerus by increasing the polyethylene thickness and/or the thickness of the humeral tray. Management of periprosthetic joint infection can be performed in one-stage, two-stage, or “three-stage” procedures all showing good outcomes with two-stage procedures being the most commonly performed. However, persistent positive culture with propriobacterium acnes can occur in up to 25% of cases. In order to limit the associated morbidity from failed revision reverse shoulder arthroplasty, continued research on best management of associated complications is warranted.

Thomas M, Bidwai A, Rangan A, Rees JL, Brownson P, Tennent D, et al. Glenohumeral osteoarthritis. Should Elb. 2016;8(3):203–14.

Berliner JL, Regalado-Magdos A, Ma CB, Feeley BT. Biomechanics of reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2015;24:150–60.

Gagey O, Hue E. Mechanics of the deltoid muscle. A new approach. Clin Orthop. 2000;375:250–7.

Lädermann A, Williams MD, Melis B, Hoffmeyer P, Walch G. Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2009;18:588–95.

• Mayne IP, Bell SN, Wright W, Coghlan JA. Acromial and scapular spine fractures after reverse total shoulder arthroplasty. Should Elb. 2016;8(2):90–100 Systematic review discussing the diagnosis, etiology and management of acromial and scapular spine fractures after reverse shoulder arthroplasty. They confidently conclude that there is no substantial evidence showing a clinically significant decrease in time to union or improved clinical outcomes when comparing ORIF with non-operative treatment.

Schwartz DG, Kang SH, Lynch TS, Edwards S, Nuber G, Zhang LQ, et al. The anterior deltoid’s importance in reverse shoulder arthroplasty: a cadaveric biomechanical study. J Shoulder Elb Surg. 2013;22(3):357–64.

Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev. 2017;1(3):72–80.PubMed

Groh GI, Groh GM. Complications rates, reoperation rates, and the learning curve in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2014;23:388–94.

Werner CM, Steinmann PA, Gilbart M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-balland-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–86.PubMed

10.

•• Abdelfattah A, Otto RJ, Simon P, Christmas KN, Tanner G, LaMartina J 2nd, et al. Classification of instability after reverse shoulder arthroplasty guides surgical management and outcomes. J Shoulder Elb Surg. 2018;27(4):e107–18 Reports on a treatment-based classification system for causes of instability broken up into three main mechanisms of (1) loss of compression, (2) loss of Containment, and (3) impingement.

11.

Cheung EV, Sarkissian EJ, Sox-Harris A, Comer GC, Saleh JR, Diaz R, et al. Instability after reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2018;27(11):1946–52.

12.

Gutiérrez S, Keller TS, Levy JC, Lee WE, Luo ZP. Hierarchy of stability factors in reverse shoulder arthroplasty. Clin Orthop Relat Res. 2008;466(3):670–6.PubMedPubMedCentral

13.

•• Chae J, Siljander M, Wiater JM. Instability in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2018;26(17):587–96 Reports on current recommendations for management of shoulder instability providing an algorithmic approach to the treatment of instability following reverse total shoulder arthroplasty. PubMed

14.

Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19(7):439–49.PubMed

15.

Crosby LA, Hamilton A, Twiss T. Scapula fractures after reverse total shoulder arthroplasty: classification and treatment. Clin Orthop Relat Res. 2011;469:2544.PubMedPubMedCentral

16.

Bohsali KI, Wirth MA, Rockwood CA. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88:2279–92.PubMed

17.

Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elb Surg. 2005;15:527–40.

18.

Boulahia A, Edwards TB, Walch G, Baratta RV. Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear. Orthopedics. 2002;25:129–33.PubMed

19.

Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly:a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg (Br). 2007;89:516–20.

20.

Chalmers PN, Rahman Z, Romeo AA, Nicholson GP. Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2014;23:737–44.

21.

Clark JC, Ritchie J, Song FS, Kissenberth MJ, Tolan SJ, Hard ND, et al. Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis. J Shoulder Elb Surg. 2012;21:36–41.

22.

Cuff D, Pupello D, Virani N, Levy J, Frankle M. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am. 2008;90:1244–51.PubMed

23.

Delloye C, Joris D, Colette A, Eudier A, Dubuc JE. Mechanical complications of total shoulder inverted prosthesis [French]. Rev Chir Orthop Reparatrice Appar Mot. 2002;88:410–4.PubMed

24.

De Wilde L, Mombert M, Van Petegem P, Verdonk R. Revision of shoulder replacement with a reversed shoulder prosthesis (Delta III): report of five cases. Acta Orthop Belg. 2001;67:348–53.PubMed

25.

Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O’Connor DP. Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2009;18:892–6.

26.

Friedman RJ, Flurin PH, Wright TW, Zuckerman JD, Roche CP. Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair. J Shoulder Elb Surg. 2017;26:662–8.

27.

Mulieri P, Dunning P, Klein S, Pupello D, Frankle M. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Am. 2010;92:2544–56.PubMed

28.

Seebauer L, Walter W, Keyl W. Reverse total shoulder arthroplasty for the treatment of defect arthropathy. Oper Orthop Traumatol. 2005;17:1–24.PubMed

29.

Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D. Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicenter study of 80 shoulders. J Bone Joint Surg (Br). 2004;86:388–95.

30.

Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89:1476–85.PubMed

31.

Teusink MJ, Pappou IP, Schwartz DG, Cottrell BJ, Frankle MA. Results of closed management of acute dislocation after reverse shoulder arthroplasty. J Shoulder Elb Surg. 2015;24:621–7.

32.

Teusink MJ, Otto RJ, Cottrell BJ, Frankle MA. What is the effect of postoperative scapular fracture on outcomes of reverse shoulder arthroplasty? J Shoulder Elb Surg. 2014;23:782–90.

33.

Boileau P, Melis B, Duperron D, Moineau G, Rumian AP, Han Y. Revision surgery of reverse shoulder arthroplasty. J Shoulder Elb Surg. 2013;22:1359–70.

34.

Henninger HB, Barg A, Anderson AE, Bachus KN, Burks RT, Tashjian RZ. Effect of lateral offset center of rotation in reverse total shoulder arthroplasty: a biomechanical study. J Shoulder Elb Surg. 2012;21:1128–35.

35.

Carpenter S, Pinkas D, Newton MD, Kurdziel MD, Baker KC, Wiater JM. Wear rates of retentive versus nonretentive reverse total shoulder arthroplasty liners in an in vitro wear simulation. J Shoulder Elb Surg. 2015;24(9):1372–9.

36.

Gutiérrez S, Luo ZP, Levy J, Frankle MA. Arc of motion and socket depth in reverse shoulder implants. Clin Biomech (Bristol, Avon). 2009;24(6):473–9.

37.

Clouthier AL, Hetzler MA, Fedorak G, Bryant JT, Deluzio KJ, Bicknell RT. Factors affecting the stability of reverse shoulder arthroplasty: a biomechanical study. J Shoulder Elb Surg. 2013;22:439–44.

38.

Abdulla I, Langohr DG, Giles JW, Johnson JA, Athwal GS. The effect of humeral polyethylene insert constraint on reverse shoulder arthroplasty biomechanics. Should Elb. 2018;10(1):25–31.

39.

Thangarajah T, Higgs D, Bayley JI, Lambert SM. Constrained fixed-fulcrum reverse shoulder arthroplasty improves functional outcome in epileptic patients with recurrent shoulder instability. World J Orthop. 2016;7(7):434.PubMedPubMedCentral

40.

Chacon A, Virani N, Shannon R, Levy JC, Pupello D, Frankle M. Revision arthroplasty with use of a reverse shoulder prosthesis-allograft composite. J Bone Joint Surg Am. 2009;91:119–27.PubMed

41.

Roche CP, Diep P, Hamilton M, Crosby LA, Flurin PH, Wright TW, et al. Impact of inferior glenoid tilt, humeral retroversion, bone grafting, and design parameters on muscle length and deltoid wrapping in reverse shoulder arthroplasty. Bull Hosp Jt Dis. 2013;71:284–93.

42.

Kassab M, Dumaine V, Babinet A, Ouaknine M, Tomeno B, Anract P. Twenty nine shoulder reconstructions after resection of the proximal humerus for neoplasm with mean 7-year follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2005;91:15–23.PubMed

43.

Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007;89:292–300.PubMed

44.

Oh JH, Shin SJ, McGarry MH, Scott JH, Heckmann N, Lee TQ. Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2014;23:1091–8.

45.

Vourazeris JD, Wright TW, Struk AM, King JJ, Farmer KW. Primary reverse total shoulder arthroplasty outcomes in patients with subscapularis repair versus tenotomy. J Shoulder Elb Surg. 2017;26:450–7.

46.

Trappey GJ 4th, O’Connor DP, Edwards TB. What are the instability and infection rates after reverse shoulder arthroplasty? Clin Orthop Relat Res. 2011;469:2505–11.PubMed

47.

Hamid N, Connor PM, Fleischli JF, D’Alessandro DF. Acromial fracture after reverse shoulder arthroplasty. Am J Orthop. 2011;40:E125–9.PubMed

48.

Hattrup SJ. The influence of postoperative acromial and scapular spine fractures on the results of reverse shoulder arthroplasty. Orthopedics. 2010;33.

49.

Lópiz Y, Rodríguez-González A, García-Fernández C, Marco F. Scapula insufficiency fractures after reverse total shoulder arthroplasty in rotator cuff arthropathy: what is their functional impact? Rev Esp Cir Ortop Traumatol. 2015;59(5):318–25.PubMed

50.

Wahlquist TC, Hunt AF, Braman JP. Acromial base fractures after reverse total shoulder arthroplasty: report of five cases. J Shoulder Elb Surg. 2011;20:1178–83.

51.

Walch G, Mottier F, Wall B, Boileau P, Molé D, Favard L. Acromial insufficiency in reverse shoulder arthroplasties. J Shoulder Elb Surg. 2009;18:495–502.

52.

Levy JC, Anderson C, Samson A. Classification of postoperative acromial fractures following reverse shoulder arthroplasty. J Bone Joint Surg Am. . https://doi.org/10.1007/s12178-020-09602-6.

53.

Camarada L, Phadnis J, Clitherow HD, et al. Mesh plates for scapula fixation. Tech Should Surg. 2015;16:79–84.

54.

Rouleau DM, Gaudelli C. Successful treatment of fractures of the base of the acromion after reverse shoulder arthroplasty: case report and review of the literature. Int J Shoulder Surg. 2013;7:149–52.PubMedPubMedCentral

55.

Otto RJ, Virani NA, Levy JC, Nigro PT, Cuff DJ, Frankle MA. Scapular fractures after reverse shoulder arthroplasty: evaluation of risk factors and the reliability of a proposed classification. J Shoulder Elb Surg. 2013;22:1514–21.

56.

Day JS, MacDonald DW, Olsen M, Getz C, Williams GR, Kurtz SM. Polyethylene wear in retrieved reverse total shoulder components. J Shoulder Elb Surg. 2012;21:667–74.

57.

Kohan EM, Chalmers PN, Salazar D, Keener JD, Yamaguchi K, Chamberlain AM. Dislocation following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2017;26:1238–45.

58.

Nam D, Kepler CK, Nho SJ, Craig EV, Warren RF, Wright TM. Observations on retrieved humeral polyethylene components from reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2010;19(7):1003–12.

59.

Terrier A, Merlini F, Pioletti DP, Farron A. Comparison of polyethylene wear in anatomical and reversed shoulder prostheses. J Bone Joint Surg (Br). 2009;91:977–82.

60.

Erickson BJ, Frank RM, Harris JD, Mall N, Romeo AA. The influence of humeral head inclination in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg. 2015;24:988–93.

61.

Edwards TB, Trappey GJ, Riley C, O’Connor DP, Elkousy HA, Gartsman GM. Inferior tilt of the glenoid component does not decrease scapular notching in reverse shoulder arthroplasty: results of a prospective randomized study. J Shoulder Elb Surg. 2012;21:641–6.

62.

Holcomb JO, Cuff D, Petersen SA, Pupello DR, Frankle MA. Revision reverse shoulder arthroplasty for glenoid baseplate failure after primary reverse shoulder arthroplasty. J Shoulder Elb Surg. 2009;18(5):717–23.

63.

Kempton LB, Balasubramaniam M, Ankerson E, Wiater JM. A radiographic analysis of the effects of prosthesis design on scapular notching following reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2011;20:571–6.

64.

Berhouet J, Garaud P, Favard L. Evaluation of the role of glenosphere design and humeral component retroversion in avoiding scapular notching during reverse shoulder arthroplasty. J Shoulder Elb Surg. 2014;23(2):151–8.

65.

Padegimas EM, Maltenfort M, Ramsey ML, Williams GR, Parvizi J, Namdari S. Periprosthetic shoulder infection in the United States: incidence and economic burden. J Shoulder Elb Surg. 2015;24(5):741–6.

66.

Frangiamore SJ, Saleh A, Kovac MF, Grosso MJ, Zhang X, Bauer TW, et al. Synovial fluid interleukin-6 as a predictor of periprosthetic shoulder infection. JBJS Am. 2015;97:63–70.PubMed

67.

Piper KE, Fernandez-Sampedro M, Steckelberg KE, Mandrekar JN, Karau MJ, Steckelberg JM, et al. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PLoS One. 2010;5(2):e9358.PubMedPubMedCentral

68.

•• Fink B, Sevelda F. Periprosthetic joint infection of shoulder arthroplasties: diagnostic and treatment options. Biomed Res Int. 2017;2017:4582756 Presents an overview of diagnostic and therapeutic options for periprosthetic joint infection of shoulder athroplasties including treatment of early infection as well one-stage and two-stage procedures for treatment of late infections. PubMedPubMedCentral

69.

Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplast. 2014;29(7):1331.

70.

Beekman P, Katusic D, Berghs B, Karelse A, de Wilde I. One-stage revision for patients with a chronically infected reverse total shoulder replacement. J Bone Joint Surg (Br). 2010;92(B):817–22.

71.

Klatte t, Junghans K, Al-Khateeb h, et al. Single-stage revision for peri- prosthetic shoulder infection: outcomes and results. Bone Joint J. 2013;95-B:391–5.PubMed

72.

Ortmaier R, Resch H, Hitzl W, et al. Treatment strategies for infection after reverse shoulder arthroplasty. Eur J Orthop Surg Traumatol. 2014;24:723–31.PubMed

73.

Strickland JP, Sperling JW, Cofield RH. The results of two-stage re- implantation for infected shoulder replacement. J Bone Joint Surg (Br). 2008;90-B:460–5.

74.

Zhang AL, Feeley BT, Schwartz BS, Chung TT, Ma CB. Management of deep postoperative shoulder infections: is there a role for open biopsy during staged treatment? J Shoulder Elb Surg. 2015;24(1):e15–20.

75.

• George DA, Volpin A, Scarponi S, Haddad FS, Romanò CL. Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review. BMC Musculoskelet Disord. 2016;17(1):52 Systematic review comparing eradication rates and functional outcomes scores of single- or two-stage exchange arthroplasty, use of permanent spacer, or resection arthroplasty for management periprosthetic shoulder infection. PubMedPubMedCentral

76.

• Gebrelul A, Green A, Schacherer T, Khazzam M. Periprosthetic humerus fractures: classification, management, and review of the literature. Ann Joint. 2018;3(6) Reports on the Kirchhoff classification system for periprosthetic shoulder fractures and provides a treatment algorithm for the best predictable functional outcome using this classification system.

77.

Kirchhoff C, Beirer M, Brunner U, Buchholz A, Biberthaler P, Crönlein M. Validation of a new classification for periprosthetic shoulder fractures. Int Orthop. 2018;1:1–7.

78.

Marsland D, Mears SC. A review of periprosthetic femoral fractures associated with total hip arthroplasty. Geriatr Orthop Surg Rehabil. 2012;3(3):107–20.PubMedPubMedCentral

79.

Kirchhoff C, Kirchhoff S, Biberthaler P. Classification of periprosthetic shoulder fractures. Unfallchirurg. 2016;119:264–72.PubMed

80.

Andersen JR, Williams CD, Cain R, Mighell M, Frankle M. Surgically treated humeral shaft fractures following shoulder arthroplasty. J Bone Joint Surg Am. 2013;95:9–18.PubMed

81.

Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M. The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency: a minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am. 2005;87(8):1697–705.PubMed

82.

Bitzer A, Rojas J, Patten IS, Joseph J, McFarland EG. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elb Surg. 2018;27(12):2145–52.

83.

Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg. British Volume. 2010;92(4):535–539.

84.

Feeley BT, Zhang AL, Barry JJ, Shin E, Ho J, Tabaraee E, et al. Decreased scapular notching with lateralization and inferior baseplate placement in reverse shoulder arthroplasty with high humeral inclination. Int J Shoulder Surg. 2014;8:65–71.PubMedPubMedCentral

85.

Lévigne C, Boileau P, Favard L, Garaud P, Molé D, Sirveaux F, et al. Scapular notching in reverse shoulder arthroplasty. J Shoulder Elb Surg. 2008;17(6):925–35.

86.

Formaini NT, Everding NG, Levy JC, Santoni BG, Nayak AN, Wilson C, et al. The effect of glenoid bone loss on reverse shoulder arthroplasty baseplate fixation. J Shoulder Elb Surg. 2015;24(11):e312–9.

87.

Jones RB, Wright TW, Zuckerman JD. Reverse total shoulder arthroplasty with structural bone grafting of large glenoid defects. J Shoulder Elb Surg. 2016;25:1425–32.

88.

Lorenzetti AJ, Streit JJ, Cabezas AF, Christmas KN, LaMartina JI, Simon P, et al. Bone graft augmentation for severe glenoid bone loss in primary reverse total shoulder arthroplasty: outcomes and evaluation of host bone contact by 2D-3D image registration. JB JS Open Access. 2017;2(3):e0015.PubMedPubMedCentral

89.

Wagner E, Houdek MT, Griffith T, Elhassan BT, Sanchez-Sotelo J, Sperling JW, et al. Glenoid bone-grafting in revision to a reverse total shoulder arthroplasty. JBJS. 2015;97(20):1653–60.

Titel: Failed Reverse Shoulder Arthroplasty and Recommendations for Revision
verfasst von: Alexander R. Markes
Edward Cheung
C. Benjamin Ma
Publikationsdatum: 01.02.2020
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 1/2020
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09602-6

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Purpose of Review

Recent Findings

Summary

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