title: Revision of an unstable hemiarthroplasty or anatomical total shoulder replacement using a reverse design prosthesis.
abstract: Instability after arthroplasty of the shoulder is difficult to correct surgically. Soft-tissue procedures and revision surgery using unconstrained anatomical components are associated with a high rate of failure. The purpose of this study was to determine the results of revision of an unstable anatomical shoulder arthroplasty to a reverse design prosthesis. Between 2004 and 2007, 33 unstable anatomical shoulder arthroplasties were revised to a reverse design. The mean age of the patients was 71 years (53 to 86) and their mean follow-up was 42 months (25 to 71). The mean time to revision was 26 months (4 to 164). Pain scores improved significantly (pre-operative visual analogue scale (VAS) of 7.2 (sd 1.6); most recent VAS 2.2 (sd 1.9); p = 0.001). There was a statistically significant increase in mean active forward elevation from 40.2° (sd 27.3) to 97.0° (sd 36.2) (p = 0.001). There was no significant difference in internal (p = 0.93) or external rotation (p = 0.40). Radiological findings included notching in five shoulders (15%) and heterotopic ossification of the inferior capsular region in three (9%). At the last follow-up 31 shoulders (94%) were stable. The remaining two shoulders dislocated at 2.5 weeks and three months post-operatively, respectively. According to the Neer rating system, there were 13 excellent (40%), ten satisfactory (30%) and ten unsatisfactory results (30%). Revision of hemiarthroplasty or anatomical total shoulder replacement for instability using a reverse design prosthesis gives good short-term results.
authors: Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905, USA.
authors: M P
authors: MP
authors: Abdel
authors: S J
authors: SJ
authors: Hattrup
authors: J W
authors: JW
authors: Sperling
authors: R H
authors: RH
authors: Cofield
authors: C R
authors: CR
authors: Kreofsky
authors: J
authors: J
authors: Sanchez-Sotelo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D062785:Hemiarthroplasty / Q000009:adverse effects; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*