Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery.
BACKGROUND
The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision indication and differences between total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) in hemiarthroplasty (HA) revision surgery.


METHODS
All patients with an indication for revision of HA were retrospectively included. Clinical evaluation consisted of pre- and post-operative constant scores, disability of arm-shoulder-hand-score (DASH), Dutch translation of the simple shoulder test ((D)SST), Oxford shoulder score test (OSS), short form (SF-36) and the complication rate.


RESULTS
From July 1994 to July 2008, 39 patients (40 shoulders) underwent revision arthroplasty. Of 19 patients (19 shoulders) we obtained a complete follow-up. The mean age at revision surgery 69 ± 10 years (range: 46-83) and the mean follow-up 41 ± 31 months (range: 10-113). In 7 cases TSA was used for revision when the cuff was intact, 12 times RSA was performed. The indications for the revision were glenoid erosion (n = 4), humeral component malposition (n = 2), cuff-pathology (n = 12) and infection (n = 1). Postoperative constant score 51.7 ± 11.4 for TSA and 31.1 ± 18.7 for RSA (P = 0.008). The DASH was 48.3 ± 25.1 and 68.7 ± 17.5, respectively (P = 0.09). DSST showed 6 ± 4 and 4 ± 4 (P = 0.414). OSS 41.3 ± 10.1 and 28.1 ± 10.3 (P = 0.017). SF-36 43.3 ± 22.1 and 24.5 ± 12.8 (P = 0.072). Four shoulders (21%) presented four complications.


CONCLUSIONS
In this study, revision surgery showed poor to reasonable postoperative results and better clinical outcome for TSA. When a revision after HA was needed, and the soft-tissue component of the shoulder was intact, a TSA proved to be a preferable solution.
Department of Orthopaedic Surgery and Traumatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Bas Pieter
BP
Hartel
Department of Orthopaedic Surgery and Traumatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Tjarco D
TD
Alta
Department of Orthopaedic Surgery and Traumatology, Vlietland Hospital, Schiedam, The Netherlands.
Miguel E
ME
Sewnath
Department of Orthopaedic Surgery and Traumatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Willem J
WJ
Willems
Clinical; outcome; reverse shoulder arthroplasty; revision surgery; total shoulder arthroplasty