Clinical outcomes following reverse shoulder arthroplasty-allograft composite for revision of failed arthroplasty associated with proximal humeral bone deficiency: 2- to 15-year follow-up

J Shoulder Elbow Surg. 2019 May;28(5):900-907. doi: 10.1016/j.jse.2018.10.023. Epub 2019 Jan 25.

Abstract

Background: Patients with pain and disability due to a prior failed shoulder arthroplasty with associated proximal humeral bone loss have limited reconstruction options. Our purpose was to report the results of a large cohort of patients treated with a reverse shoulder allograft-prosthetic composite (APC).

Methods: Between 2002 and 2012, a total of 73 patients were treated with a reverse shoulder APC and had adequate follow-up. Clinical outcome scores, range of motion, and radiographic evidence of failure were assessed. The minimum follow-up period was 2 years, with an average of 67.9 months (range, 21-157 months). Of the patients, 43 had more than 5 years' follow-up and 12 had more than 10 years' follow-up.

Results: The total American Shoulder and Elbow Surgeons score improved from 33.8 to 51.4 (P < .0001), and the Simple Shoulder Test score improved from 1.3 to 3.5 (P < .0001). Good to excellent results were reported in 42 of 60 patients (70%), 10 patients (17%) reported satisfactory results, and 8 patients (13%) were unsatisfied. Range of motion improved in forward flexion (49° to 75°, P < .001) and abduction (45° to 72°, P < .001). Revision was required in 14 patients (19%) for periprosthetic fracture (n = 6), instability (n = 2), glenosphere dissociation (n = 2), humeral loosening (n = 2), and infection (n = 2) at a mean of 38 months postoperatively. The reoperation-free survival rate of all reconstructions was 88% (30 of 34) at 5 years, 78% (21 of 27) at 10 years, and 67% (8 of 12) beyond 10 years. Ten patients had radiographic evidence of humeral loosening at final follow-up, and 2 required revision.

Conclusions: The use of a reverse total shoulder APC provides reliable pain relief and improved range of motion, with an acceptable rate of complications. Although ultimate function achieved is limited, patient satisfaction remains high.

Keywords: APC; RSA; Reverse total shoulder arthroplasty; allograft; proximal humeral bone loss; revision.

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Shoulder / adverse effects*
  • Arthroplasty, Replacement, Shoulder / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Humerus / surgery
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Periprosthetic Fractures / etiology
  • Periprosthetic Fractures / surgery*
  • Postoperative Complications / etiology*
  • Postoperative Complications / surgery*
  • Range of Motion, Articular
  • Reoperation / methods
  • Shoulder Joint / surgery
  • Shoulder Prosthesis*
  • Time Factors
  • Treatment Outcome