CORR Insights^®: Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design

Excerpt

Care of patients with proximal humerus fractures and shoulder arthritis has advanced tremendously in the last half-century. What began as simple fracture management and palliative care for the patient with arthritis, was transformed in the 1970s by Neer’s seminal work [1], and now offers surgeons and their patients advanced surgical options for degenerative joint disease of the glenohumeral joint, complex proximal humerus fractures, and even arthritis in patients with rotator cuff deficiencies. As the use of shoulder arthroplasty has increased, so have the complications and need for revision arthroplasty. Wieser and colleagues have pointed out that failure of anatomic shoulder arthroplasty often results in conversion of anatomic constructs to semi-constrained devices such as reverse shoulder arthroplasty. As surgeons, we strive to minimize surgical trauma; intuitively, stem removal is potentially more destructive than retention. While reverse shoulder arthroplasty is not a panacea, it has become one of the most common methods of revision, due to the nature of the soft-tissue or bone deficiencies. As a result, prosthetic designs are evolving to platform or convertible stems; theoretical advantages of these stems include the ability to serve as a single stem option for anatomic or reverse replacements and the ease of conversion from an anatomic construct to a reverse replacement in situ. The authors of the current study state the problems with stem removal and attempt to demonstrate the advantages of a convertible implant. …