Reverse shoulder arthroplasty after failed pectoralis major tendon transfer with a minimum follow-up of 5 years. A case series.
BACKGROUND
Treatment strategies after failed pectoralis major tendon transfer (PMTT) are scarce in literature and no information is available for patients treated with reverse shoulder arthroplasty (RSA) for failed PMTT.


METHODS
We performed a retrospective outcome study of all patients who underwent revision with RSA after failed PMTT at our institution. From 1999 to 2009 we included 8 patients (8 shoulders). The minimum follow-up was 5 years with a mean follow-up time of 97 months (range, 64-134). Clinical and radiological evaluation comprised range of motion, Constant Murley score (CMS), Simple Shoulder Test (SST) as well as standard X-rays in 2 planes. Pain was measured using VAS pain scale. The patients were asked to rate their satisfaction at final follow-up.


RESULTS
All outcome measures improved significantly post-surgical compared to pre-surgical, including the CMS (17.8-62.8), SST (1.8-7.3) and VAS (7.1-1). Active abduction and anterior flexion improved significantly (p < .001) from 65.6° to 125° and from 62.5° to 136.3°, respectively. There were 2 complications. One patient sustained transient musculocutaneous nerve palsy that resolved completely after 5 months and one patient sustained postoperative hematoma and had to be revised 4 days after surgery. 4 (50%) patients rated their results as excellent and 4 (50%) rated them as good.


CONCLUSIONS
RSA is a good option for treating patients after failed pectoralis major tendon transfer. After a minimum follow-up of 5 years, functional outcome is good and patient satisfaction is high.


METHODS
Level IV, Case series, Treatment study.
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: r.ortmaier@gmail.com.
Reinhold
R
Ortmaier
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: fabian.plachel@gmail.com.
Fabian
F
Plachel
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: s.lederer@salk.at.
Stefan
S
Lederer
Department of Biostatistics, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria. Electronic address: wolfgang.hitzl@pmu.ac.at.
Wolfgang
W
Hitzl
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: a.auffarth@salk.at.
Alexander
A
Auffarth
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: n.matis@salk.at.
Nicholas
N
Matis
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020 Salzburg, Austria. Electronic address: h.resch@salk.at.
Herbert
H
Resch
D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010369:Pectoralis Muscles / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery; D019534:Shoulder Impingement Syndrome / Q000601:surgery; D013709:Tendon Transfer / Q000009:adverse effects* / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome