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Current Reviews in Musculoskeletal Medicine

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06.06.2020 | Reverse Shoulder Arthroplasty (C Chambers and E Craig, Section Editors)

Hemiarthroplasty and Total Shoulder Arthroplasty Conversion to Reverse Total Shoulder Arthroplasty

verfasst von: Alicia K. Harrison, Michael L. Knudsen, Jonathan P. Braman

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 4/2020

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Abstract

Purpose of Review

The incidence of shoulder arthroplasty is increasing dramatically for primary arthroplasty but also for revision arthroplasty. Revision to reverse total shoulder arthroplasty is increasingly the salvage operation for failed primary arthroplasty. The purpose of this review is to explore the indications for and results of revision reverse total shoulder arthroplasty.

Recent Findings

Despite relatively high complication and reoperation rates with revision shoulder replacement, revision of failed hemiarthroplasty or total shoulder arthroplasty to reverse total shoulder arthroplasty improves outcomes for many patients. A failed hemiarthroplasty or total shoulder arthroplasty is frequently disabling for the patient and because the surgical revision options are often limited only to reverse total shoulder arthroplasty, the potential improvement is often worth the higher surgical complication or reoperation rate.

Summary

Due to the challenges inherent in revision arthroplasty, revision of primary arthroplasty to reverse total shoulder arthroplasty, outcomes are poorer than primary reverse total shoulder arthroplasty. Despite these limitations, patient postoperative pain and function do increase from preoperative levels making conversion of hemiarthroplasty or anatomic total shoulder to reverse total shoulder arthroplasty an important option for a challenging problem.

Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011 Dec 21;93(24):2249–54. https://doi.org/10.2106/JBJS.J.01994.CrossRefPubMed

• Harjula JNE, Paloneva J, Haapakoski J, Kukkonen J, Äärimaa V. Finnish Shoulder Arthroplasty Registry Group. Increasing incidence of primary shoulder arthroplasty in Finland - a nationwide registry study. BMC Musculoskelet Disord. 2018;19(1):245. https://doi.org/10.1186/s12891-018-2150-3The purpose of this study was to investigate the incidence of primary shoulder arthroplasty in Finland. Methods: We analyzed nationwide data from the Finnish Arthroplasty Register (FAR) and the Finnish National Hospital Discharge Register (NHDR) during time period 2004–2015. The primary outcome variable was the incidence of shoulder arthroplasty per 100,000 person-years stratified by age, sex, and year of surgery. The secondary outcome variables were surgical indication, arthroplasty type, and prosthesis model. Results: The number of primary shoulder arthroplasties was 7504 (women = 4878, men = 2625). The rate of operations increased from 6 to 15 per 100,000 person-years among men, and 11 to 26 per 100,000 person-years among women. The indication for arthroplasty was osteoarthritis in 56%, acute fracture in 21%, inflammatory arthritis in 13%, and rotator cuff arthropathy in 4% of the cases. Hemiarthroplasties accounted for 66%, total shoulder arthroplasties 8%, and reverse shoulder arthroplasties 12% of the cases; 14% of the cases was missing. During the 12-year study period, the incidence of hemiarthroplasties decreased by 23% and the number of total shoulder and reverse shoulder arthroplasty increased by 500 and 4500%, respectively. Conclusions: The incidence of primary shoulder arthroplasty has increased by 160% during the study period in Finland. The incidence of hemiarthroplasties decreased while total and reverse shoulder arthroplasties increased. CrossRefPubMedPubMedCentral

•• Wagner ER, Chang MJ, Welp KM, Solberg MJ, Hunt TJ, Woodmass JM, et al. The impact of the reverse prosthesis on revision shoulder arthroplasty: analysis of a high-volume shoulder practice. J Shoulder Elbow Surg. 2019;28(2):e49–56. https://doi.org/10.1016/j.jse.2018.08.002Background: Since the approval of reverse shoulder arthroplasty (RSA) in 2004, the use of shoulder arthroplasty increased dramatically. Although the success of RSA in the revision setting has been demonstrated, there remains a paucity of studies examining the epidemiology of RSA in revision arthroplasty. This study describes trends of revision arthroplasty during the “era of the reverse,” from 2005 through 2016. Methods: In a multicenter retrospective analysis, we analyzed 274 revision shoulder arthroplasties converted to a RSA (n= 182), anatomic total shoulder arthroplasty (TSA,n= 68), or hemiarthroplasty (n= 24) from 2005 to 2016. Demographics, surgical indications, and types of prosthesis were analyzed. Results: The number of revision arthroplasties increased over 12 years. From 2005 to 2010, TSA (33%) or hemiarthroplasty (16%) was used in similar rates as RSA (51%). From 2011 to 2016, there was a much higher incidence of revision arthroplasty with RSA (78%) compared with TSA (19%) or hemiarthroplasty (3%). Specifically, the number of RSAs increased in 2011 to 2016 compared with 2005 to 2010 in patients aged younger than 60 years, obese patients, patients with indications of glenoid loosening, and those with a diagnosis of diabetes mellitus or rheumatoid arthritis. Conclusions: The use of RSA for revision arthroplasty increased over the “era of the reverse” and became the majority by 2016. The reverse prosthesis has had expanding indications regarding both patient demographics and pathology. This study demonstrates the reverse prosthesis has had a similar and even more profound effect on revision shoulder arthroplasty than what has previously been well documented in the primary setting. CrossRefPubMed

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. 2006;15:527–40.CrossRef

•• Sheth MM, Sholder D, Getz CL, Williams GR, Namdari S. Revision of failed hemiarthroplasty and anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty. Shoulder Elbow Surg. 2019;28(6):1074–81. https://doi.org/10.1016/j.jse.2018.10.026Background: The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Revision of failed anatomic arthroplasty to reverse total shoulder arthroplasty has shown promise alongside concerning complication rates. Methods: Patients who underwent revision shoulder arthroplasty during a 7-year period at a tertiary care health system were identified. Presurgical and operative data were analyzed for 110 patients who met inclusion and exclusion criteria. Patients were contacted at a mean follow-up of 57 ± 26 months (range, 23–113 months) from revision surgery for functional outcomes scores, reoperations, and implant survival. Results: Implant survival was 92% at 2 years and 74% at 5 years. Mean American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, and visual analog scale pain scores were 63 ± 24 (range, 5–97), 60 ± 25 (range, 0–100), and 2.9 ± 2.9 (range, 0–10), respectively. Seventy percent of patients were “very satisfied” or “satisfied with their outcome.” Complications occurred in 18 patients (20%), and 10 patients (11%) underwent reoperation. Conclusions: Modest patient results and satisfaction can be achieved with revision of a failed anatomic arthroplasty to a reverse total shoulder arthroplasty. As is typical of revision surgery, complications are common and can compromise results. Further study is needed to identify factors that may contribute to successful outcomes. CrossRef

•• Shields E, Wiater JM. Patient outcomes after revision of anatomic total shoulder arthroplasty to reverse shoulder arthroplasty for rotator cuff failure or component loosening: a matched cohort study. J Am Acad Orthop Surg. 2019;27(4):e193–8. https://doi.org/10.5435/JAAOS-D-17-00350Purpose: To compare outcomes after conversion of anatomic total shoulder arthroplasty (aTSA) to reverse total shoulder arthroplasty (RTSA) and a matched cohort. Methods: Patients converted from aTSA to RTSA for rotator cuff failure or component loosening and a primary RTSA matched cohort were retrospectively identified from a prospective database. Demographics and preoperative and postoperative outcomes were obtained and compared. Results: Age, sex, body mass index, follow-up length, and preoperative function were similar between revision (n= 35) and primary (n= 70) groups. At final follow-up, visual analog scale pain (2.4 ± 2.8 vs 1.7 ± 2.8;P= 0.24) and American Shoulder and Elbow Surgeons (68 ± 26 vs 76 ± 24;P= 0.14) scores were similar. The revision group had worse subjective shoulder value scores (63 ± 30 vs 79 ± 21;P= 0.002), satisfaction (74% vs 90%;P= 0.03), and more complications (31% vs 13%;P= 0.02). Conclusion: Revision of aTSA to RTSA for component loosening or rotator cuff failure results in function comparable with primary RTSA; however, more complications, worse subjective shoulder value scores, and lower patient satisfaction should be expected. Level of Evidence: Level III, retrospective comparative. CrossRefPubMed

• Cox JL, McLendon PB, Christmas KN, Simon P, Mighell MA, Frankle MA. Clinical outcomes following reverse shoulder arthroplasty-allograft composite for revision of failed arthroplasty associated with proximal humeral bone deficiency: 2- to 15-year follow-up. J Shoulder Elbow Surg. 2019;28(5):900–7. https://doi.org/10.1016/j.jse.2018.10.023Background: Patients with pain and disability due to a prior failed shoulder arthroplasty with associated proximal humeral bone loss have limited reconstruction options. Our purpose was to report the results of a large cohort of patients treated with a reverse shoulder allograft-prosthetic composite (APC). Methods: Between 2002 and 2012, a total of 73 patients were treated with a reverse shoulder APC and had adequate follow-up. Clinical outcome scores, range of motion, and radiographic evidence of failure were assessed. The minimum follow-up period was 2 years, with an average of 67.9 months (range, 21–157 months). Of the patients, 43 had more than 5 years’ follow-up and 12 had more than 10 years’ follow-up. Results: The total American Shoulder and Elbow Surgeons score improved from 33.8 to 51.4 (P< .0001), and the Simple Shoulder Test score improved from 1.3 to 3.5 (P< .0001). Good to excellent results were reported in 42 of 60 patients (70%), 10 patients (17%) reported satisfactory results, and 8 patients (13%) were unsatisfied. Range of motion improved in forward flexion (49 to 75°,P< .001) and abduction (45 to 72°,P< .001). Revision was required in 14 patients (19%) for periprosthetic fracture (n= 6), instability (n= 2), glenosphere dissociation (n= 2), humeral loosening (n= 2), and infection (n= 2) at a mean of 38 months postoperatively. The reoperation-free survival rate of all reconstructions was 88% (30 of 34) at 5 years, 78% (21 of 27) at 10 years, and 67% (8 of 12) beyond 10 years. Ten patients had radiographic evidence of humeral loosening at final follow-up, and 2 required revision. Conclusions: The use of a reverse total shoulder APC provides reliable pain relief and improved range of motion, with an acceptable rate of complications. Although ultimate function achieved is limited, patient satisfaction remains high. CrossRefPubMed

•• Holschen M, Siemes MK, Witt KA, Steinbeck J. Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty. Bone Joint J. 2018;100-B(6):761–6. https://doi.org/10.1302/0301-620X.100B6.BJJ-2017-1280.R1Aims: The reasons for failure of a hemirthroplasty (HA) when used to treat a proximal humeral fracture include displaced or necrotic tuberosities, insufficient metaphyseal bone-stock, and rotator cuff tears. Reverse total shoulder arthroplasty (rTSA) is often the only remaining form of treatment in these patients. The aim of this study was to evaluate the clinical outcome after conversions from a failed HA to rTSA. Material and Methods: A total of 35 patients, in whom a HA, as treatment for a fracture of the proximal humerus, had failed, underwent conversion to a rTSA. A total of 28 were available for follow-up at a mean of 61 months (37 to 91), having been initially reviewed at a mean of 20 months (12 to 36) postoperatively. Having a convertible design, the humeral stem could be preserved in nine patients. The stem was removed in the other 19 patients and a conventional rTSA was implanted. At final follow-up, patients were assessed using the American Shoulder and Elbow Surgeons (ASES) score, the Constant Score, and plain radiographs. Results: At final follow-up, the mean ASES was 59 (25 to 97) and the mean adjusted Constant Score was 63% (23 to 109%). Both improved significantly (P< 0.001). The mean forward flexion was 104° (50 to 155°) and mean abduction was 98° (60 to 140°). Nine patients (32%) had a complication; two had an infection and instability, respectively; three had a scapular fracture; and one patient each had delayed wound healing and symptomatic loosening. If implants could be converted to a rTSA without removal of the stem, the operating time was shorter (82 min vs 102 min;P= 0.018). Conclusion: After failure of a HA in the treatment of a proximal humeral fracture, conversion to a rTSA may achieve pain relief and improved shoulder function. The complication rate is considerable. CrossRefPubMed

Weber-Spickschen TS, Alfke D, Agneskirchner JD. The use of a modular system to convert an anatomical total shoulder arthroplasty to a reverse shoulder arthroplasty: clinical and radiological results. Bone Joint J. 2015;97-B:1662–7.CrossRef

10.

• Valenti P, Katz D, Kany J, Werthel JD. Convertible glenoid components facilitate revisions to reverse shoulder arthroplasty easier: retrospective review of 13 cases. Am J Orthop (Belle Mead NJ). 2018;47(2). https://doi.org/10.12788/ajo.2018.0008Removal of a cemented glenoid component often leads to massive glenoid bone loss, which makes it difficult to implant a new glenoid baseplate. The purpose of this study was to demonstrate the feasibility of revisions with a completely convertible system and to report clinical and radiographic results of a retrospective review of 13 cases. Between 2003 and 2011, 104 primary total shoulder arthroplasties (TSAs) were performed with an uncemented glenoid component in our group. Of these patients, 13 (average age, 64 years) were revised to reverse shoulder arthroplasty (RSA) using a modular convertible platform system and were included in this study. Average follow-up after revision was 22 months. Outcome measures included pain, range of motion, Constant-Murley scores, Simple Shoulder Tests, and subjective shoulder values. Active flexion increased significantly from a mean of 93° (range, 30–120°) to 138° (range, 95–170°) (P= 0.021), and active external rotation increased significantly from 8° (range, − 20–15°) to 25° (range, − 10–60°). Mean pain scores significantly improved from 4.2 to 13.3 points. The mean Constant Scores improved from 21 (range, 18–32) to 63 (range, 43–90). Subjectively, 12 patients rated their shoulder as better or much better than preoperatively. This retrospective study shows that a complete convertible system facilitates conversion of TSAs to RSAs with excellent pain relief and a significant improvement in shoulder function.

11.

Werner BS, Boehm D, Gohlke F. Revision to reverse shoulder arthroplasty with retention of the humeral component. Acta Orthop. 2013;84:473–8.CrossRef

12.

Ortmaier R, Resch H, Matis N, Blocher M, Auffarth A, Mayer M, et al. Reverse shoulder arthroplasty in revision of failed shoulder arthroplasty—outcome and follow-up. Int Orthop. 2013;37:67–75.CrossRef

13.

Castagna A, Delcogliano M, de Caro F, Ziveri G, Borroni M, Gumina S, et al. Conversion of shoulder arthroplasty to reverse implants: clinical and radiological results using a modular system. Int Orthop. 2013;37:1297–305.CrossRef

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Abdel MP, Hattrup SJ, Sperling JW, Cofield RH, Kreofsky CR, Sanchez-Sotelo J. Revision of an unstable hemiarthroplasty or anatomical total shoulder replacement using a reverse design prosthesis. Bone Joint J. 2013;95-B:668–72.CrossRef

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Walker M, Willis MP, Brooks JP, Pupello D, Mulieri PJ, Frankle MA. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elb Surg. 2012;21:514–22.CrossRef

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Patel DN, Young B, Onyekwelu I, Zuckerman JD, Kwon YW. Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elb Surg. 2012;21:1478–83.CrossRef

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Melis B, Bonnevialle N, Neyton L, Lévigne C, Favard L, Walch G, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elb Surg. 2012;21:342–9.CrossRef

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Kelly JD, Zhao JX, Hobgood ER, Norris TR. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elb Surg. 2012;21:1516–25.CrossRef

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Flury MP, Frey P, Goldhahn J, Schwyzer HK, Simmen BR. Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure—midterm results. Int Orthop. 2011;35:53–60.CrossRef

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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.CrossRef

21.

Izquierdo R, Voloshin I, Edwards S, Freehill MQ, Stanwood W, Wiater JM, et al. J Am Acad Orthop Surg. 2010;18(6):375–82.CrossRef

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Lo IK, Litchfield RB, Griffin S, Faber K, Patterson SD, Kirkley A. Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. A prospective, randomized trial. J Bone Joint Surg Am. 2005;87:2178–85.PubMed

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Dines JS, Fealy S, Strauss EJ, Allen A, Craig EV, Warren RF, et al. Outcomes analysis of revision total shoulder replacement. J Bone Joint Surg Am. 2006;88:1494–500.CrossRef

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Sajadi KR, Kwon YW, Zuckerman JD. Revision shoulder arthroplasty: an analysis of indications and outcomes. J Shoulder Elb Surg. 2010;19:308–13.CrossRef

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•• Sheth MM, Sholder D, Abboud J, Lazarus MD, Ramsey ML, Williams GR, et al. Revision of failed hemiarthroplasty for painful glenoid arthrosis to anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2018;27(10):1884–90. https://doi.org/10.1016/j.jse.2018.03.018Background: The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Painful glenoid arthrosis following hemiarthroplasty is a common cause of reoperation, and conversion to anatomic total shoulder arthroplasty is one option. Methods: We identified patients who underwent revision of painful hemiarthroplasty to total shoulder arthroplasty over a 15-year period in a single tertiary-care health system. Presurgical and operative data were analyzed for 28 patients who met the inclusion and exclusion criteria. Patients were contacted at a minimum of 2 years’ follow-up after revision surgery for functional outcome scores, reoperations, and implant survival. Results: The 2- and 5-year implant survival rates were 93% and 86%, respectively. Functional outcomes were obtained from 21 patients with surviving implants. The mean American Shoulder and Elbow Surgeons score, visual analog scale score for pain, and Single Assessment Numerical Evaluation score were 78 ± 20, 2.3 ± 2.6, and 71 ± 24, respectively. The mean Short Form 12 mental and physical scores were 49 ± 10 and 43 ± 9, respectively. Of the patients, 17 (81%) were either satisfied or very satisfied with their outcome. Complications were seen in 10 patients (36%), and 6 patients (21%) required reoperation. Conclusions: Anatomic total shoulder arthroplasty following hemiarthroplasty can achieve successful outcomes and implant survival rates. Given our poor understanding of reverse shoulder arthroplasty longevity, this procedure should remain an option for patients with glenoid arthrosis and an intact rotator cuff. CrossRefPubMed

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• Petkovic D, Kovacevic D, Levine WN, Jobin CM. Management of the failed arthroplasty for proximal humerus fracture. J Am Acad Orthop Surg. 2019;27(2):39–49. https://doi.org/10.5435/JAAOS-D-17-00051A variety of reasons exist for failure of arthroplasty performed for management of proximal humerus fracture. Revision surgery for these failures is complex and has a high likelihood of inferior outcomes compared with primary arthroplasty. Successful management requires consideration of various modes of failure including tuberosity malunion or resorption, rotator cuff deficiency, glenoid arthritis, bone loss, component loosening, stiffness, or infection. Although revision to a reverse shoulder arthroplasty is an appealing option to address instability, rotator cuff dysfunction, and glenoid arthritis, there are concerns with higher complication rates and inferior results compared with primary reverse replacement. Any treatment plan should appropriately address the cause for failure to optimize outcomes. CrossRefPubMed

34.

•• Kim K, Elbuluk A, Jia N, Osmani F, Levieddin J, Zuckerman J, et al. Revision shoulder arthroplasty: Patient-reported outcomes vary according to the etiology of revision. J Orthop. 2018;15(4):922–6. https://doi.org/10.1016/j.jor.2018.08.030Background: The study evaluates patient-reported outcomes in revision shoulder arthroplasty (RevSA) according to etiology. Methods: Twenty-three consecutive RevSA (minimum 2-year follow-up) were retrospectively reviewed. Patient-reported outcome (PRO) scores and range of motion were compared by the type of revision procedure and indication. Results: EQ5D-QOL, VAS-pain, ASES, and forward elevation improved after RevSA. The infection group had least improvements. Revision to a reverse total shoulder arthroplasty (RTSA) demonstrated the most improvement in VAS-pain, forward elevation, and ASES. Conclusions: Revision to RTSA significantly improved PRO scores compared with hemi- or total shoulder arthroplasty. RevSA for infection demonstrated the least improvement in outcomes. CrossRefPubMedPubMedCentral

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Titel: Hemiarthroplasty and Total Shoulder Arthroplasty Conversion to Reverse Total Shoulder Arthroplasty
verfasst von: Alicia K. Harrison
Michael L. Knudsen
Jonathan P. Braman
Publikationsdatum: 06.06.2020
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 4/2020
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09649-5

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Hemiarthroplasty and Total Shoulder Arthroplasty Conversion to Reverse Total Shoulder Arthroplasty

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Recent Findings

Summary

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