title: Early Outcomes Following Metal-on-Metal Reverse Total Shoulder Arthroplasty in Patients Younger Than 50 Years.
abstract: Reverse total shoulder arthroplasty (TSA) is a useful intervention for older patients with glenohumeral arthritis and a deficient rotator cuff. However, as a semiconstrained prosthesis, conventional reverse TSA implanted in a young patient could fail over time secondary to polyethylene wear and subsequent osteolysis. A metal-on-metal prosthesis may avoid this type of failure. The purpose of this study is to assess the outcomes in an initial cohort of young patients who underwent reverse TSA using a metal-on-metal prosthesis. Surgical indications included age younger than 50 years with a functioning deltoid and significant impairment of shoulder function with irreparable rotator cuff due to tumor resection, arthritis, or revision surgery. Nine patients with an average age of 37 years underwent implantation of a custom metal-on-metal reverse TSA prosthesis. All patients had a minimum 12-month follow-up or a failure of their procedure requiring revision surgery prior to 1 year. American Shoulder and Elbow Surgeons (ASES) scores, Constant scores, and range of motion were recorded and analyzed pre- and postoperatively to assess improvement, and all complications were noted. Average ASES score improved from 47 points preoperatively to 73.4 points postoperatively (P=.013). Average Constant and adjusted Constant scores improved from 20.8 points and 16% preoperatively to 61.8 points and 67.3% postoperatively, respectively (P=.019 and P=.068). Mean postoperative active forward flexion and active external rotation were 119.4° and 10°, respectively. Complications included the following: 3 patients sustained a postoperative dislocation, 1 patient had a glenoid fracture and complete loss of fixation of the baseplate, and 1 patient experienced dissociation of the glenosphere from the base-plate. Although metal-on-metal reverse TSA may appear to be an attractive choice in the treatment of young patients with limited reconstructive options, postoperative outcomes are disappointing, and the complication rate is high. [Orthopedics.2016; 39(5):e957-e961.].
authors.forename: Clay
authors.initials: C
authors.lastname: Riley
authors.forename: John
authors.initials: J
authors.lastname: Idoine
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shishani
authors.forename: Reuben
authors.initials: R
authors.lastname: Gobezie
authors.forename: Bradley
authors.initials: B
authors.lastname: Edwards
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001168:Arthritis / Q000601:surgery*; D000072228:Arthroplasty, Replacement, Shoulder / Q000295:instrumentation / Q000379:methods*; D057645:Deltoid Muscle / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects; D008297:Male; D061825:Metal-on-Metal Joint Prostheses; D008875:Middle Aged; D019919:Prosthesis Implantation; D016059:Range of Motion, Articular; D012086:Reoperation; D012399:Rotation; D017006:Rotator Cuff / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome