title: Reverse shoulder arthroplasty in patients with pre-operative impairment of the deltoid muscle.
abstract: The indications for reverse shoulder arthroplasty (RSA) continue to be expanded. Associated impairment of the deltoid muscle has been considered a contraindication to its use, as function of the RSA depends on the deltoid and impairment of the deltoid may increase the risk of dislocation. The aim of this retrospective study was to determine the functional outcome and risk of dislocation following the use of an RSA in patients with impaired deltoid function. Between 1999 and 2010, 49 patients (49 shoulders) with impairment of the deltoid underwent RSA and were reviewed at a mean of 38 months (12 to 142) post-operatively. There were nine post-operative complications (18%), including two dislocations. The mean forward elevation improved from 50° (sd 38; 0° to 150°) pre-operatively to 121° (sd 40; 0° to 170°) at final follow-up (p < 0.001). The mean Constant score improved from 24 (sd 12; 2 to 51) to 58 (sd 17; 16 to 83) (p < 0.001). The mean Single Assessment Numeric Evaluation score was 71 (sd 17; 10 to 95) and the rate of patient satisfaction was 98% (48 of 49) at final follow-up. These results suggest that pre-operative deltoid impairment, in certain circumstances, is not an absolute contraindication to RSA. This form of treatment can yield reliable improvement in function without excessive risk of post-operative dislocation.
authors.affiliation: La Tour Hospital, Division of Orthopaedics and Trauma Surgery, Rue J.D. Maillard 3, Meyrin, Switzerland. alexandre.laedermann@latour.ch
authors.forename: A
authors.initials: A
authors.lastname: Lädermann
authors.forename: G
authors.initials: G
authors.lastname: Walch
authors.forename: P J
authors.initials: PJ
authors.lastname: Denard
authors.forename: P
authors.initials: P
authors.lastname: Collin
authors.forename: F
authors.initials: F
authors.lastname: Sirveaux
authors.forename: L
authors.initials: L
authors.lastname: Favard
authors.forename: T B
authors.initials: TB
authors.lastname: Edwards
authors.forename: O
authors.initials: O
authors.lastname: Kherad
authors.forename: P
authors.initials: P
authors.lastname: Boileau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D000075202:Contraindications; D057645:Deltoid Muscle / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000209:etiology; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Complications; Deltoid impairment; Function; Indications; Muscle insufficiency; Prosthesis; Reverse shoulder arthroplasty