title: The incidence of radiographic aseptic loosening of the humeral component in reverse total shoulder arthroplasty.
abstract: BACKGROUND
  The reverse total shoulder arthroplasty (RTSA) has been used in the treatment of complex shoulder problems. The incidence of aseptic loosening of the humeral component has not been previously reported.
  
  
  METHODS
  This is a multicenter, retrospective, blinded, case-control radiographic review of 292 patients to determine the rate of humeral stem loosening. There were 177 cemented and 115 press-fit humeral components. Radiographs were critiqued for radiolucent lines adjacent to the humeral stem based on the method described by Gruen et al.
  
  
  RESULTS
  The overall rate of loosening was 0.74%. No radiographic loosening occurred in the press-fit group (115 stems). In the cemented group (177 stems), 2 shoulders (1.18%) were identified with radiographically loose stems. No loosening occurred in the press-fit group. No statistically significant difference was found in humeral stem loosening when the press-fit group and the cemented group were compared (P = .198).
  
  
  CONCLUSIONS
  Our study indicates the cemented or press-fit RTSA system will result in a low incidence of radiolucent lines and radiographic loosening. Compared with historical survivorship of conventional anatomic total shoulder arthroplasty, RTSA shows a lower rate of radiographic stem loosening at a mean of 38.46 months.
  
  
  CONCLUSIONS
  The RTSA has a low incidence of humeral stem loosening at midterm. These results underscore the importance of careful selection of patients to provide the benefits of this surgical technique. Press-fit fixation may provide a lower risk to stem loosening.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Gilot
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA. Electronic address: mauricioalvarez07@yahoo.com.
authors.forename: Andres M
authors.initials: AM
authors.lastname: Alvarez-Pinzon
authors.affiliation: Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wright
authors.affiliation: Department of Orthopaedic Surgery, Clinique du Sport de Bordeaux-Mérignac, Mérignac, France.
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Flurin
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Krill
authors.affiliation: Department of Orthopaedic Surgery, Palm Beach Shoulder Service, Palm Beach, FL, USA.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Routman
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Zuckerman
mesh_terms: D019643:Arthroplasty, Replacement / Q000379:methods*; D001843:Bone Cements / Q000627:therapeutic use*; D016022:Case-Control Studies; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging*; D015994:Incidence; D007595:Joint Prosthesis / Q000009:adverse effects*; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D016037:Single-Blind Method
chemical_list: D001843:Bone Cements
keywords: Reverse shoulder arthroplasty; failed shoulder replacement; humeral fixation; radiographic stem loosening; satisfactory outcome