title: Reverse shoulder prosthesis in the treatment of locked anterior shoulders: a comparison with classic reverse shoulder indications.
abstract: BACKGROUND
  Locked anterior shoulder (LAS) with static instability and anterior glenoid bone loss is challenging in the elderly population. Reverse shoulder arthroplasty (RSA) has been employed in treating these patients. No study has compared RSA for LAS with classically indicated RSA.
  
  
  METHODS
  A retrospective case-control study of patients treated with RSA for LAS with glenoid bone loss and static instability was performed using matched controls treated with primary RSA for classic indications. Twenty-four cases and 48 controls were evaluated. Average follow-up was 25.5 months, and median age was 76 years. Motion, outcome assessments, and postoperative radiographs were compared.
  
  
  RESULTS
  Preoperatively, LAS had significantly less rotation and lower baseline outcome scores. Glenoid bone grafting was more common (P = .05) in the control group (26%) than in the LAS group (6.3%). Larger glenospheres were used more often (P = .001) in the LAS group (75%) than in the control group (29%). Both groups demonstrated significant improvements in pain, function, and outcome scores. Postoperatively, the control group had significantly better elevation and functional outcome scores. With the exception of flexion and Simple Shoulder Test score, effectiveness of treatment was similar between groups. Postoperative acromion stress fractures were seen in 21% of LAS patients and 9% of controls (P = .023) with a predominance of type 3 fractures in LAS. Two LAS patients remained dislocated.
  
  
  CONCLUSIONS
  Patients with LAS treated with RSA can anticipate improvements in pain and function by use of larger glenospheres, often without the need for glenoid bone grafting. Worse postoperative motion and function and a higher incidence of acromion stress fracture may be expected.
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kurowicki
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Triplet
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Enesi
authors.initials: E
authors.lastname: Momoh
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Molly A
authors.initials: MA
authors.lastname: Moor
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA. Electronic address: jonlevy123@yahoo.com.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D015775:Fractures, Stress / Q000209:etiology; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery*; D000072227:Shoulder Prosthesis
keywords: Reverse shoulder; acromion fracture; anterior instability; glenoid bone loss; shoulder dislocation; shoulder subluxation