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Unstable Reverse Total Shoulder Arthroplasty: How to Avoid and Manage

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Shoulder Arthroplasty

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Abstract

Although the implementation of reverse total shoulder arthroplasty (RTSA) is more common today, the complication rates in the literature still reach as high as 68%. The instability following the RTSA is the most frequent reason for revision surgery and the most difficult problem to fix. Moreover, this complication has a very high recurrence rate. The factors affecting the stability of the RTSA are compressive forces, humerosocket depth, and glenosphere dimensions. The risk factors for instability are the component malposition, insufficient soft tissue tension and soft tissue coverage, choice of deltopectoral approach, subscapularis deficiency, body mass index over 30 kg/m2, male gender, any previous history of surgery performed on the affected shoulder, impingement of the components, heterotopic ossification, axillary nerve palsy, and asymmetrical polyethylene wear. Following the development of the instability, deltoid muscle and axillary nerve integrity, glenoid and humeral component position, and bone pathologies and defects should be evaluated. If these are normal, close reduction can be considered as the initial intervention in these patients. Open reduction is the second option if the close reduction fails. In these patients, glenoid and humeral components, polyethylene insert wear, bone pathologies and defects, and soft tissue tension should be evaluated. Appropriate soft tissue tension can be restored by increasing the humeral length or lateralization of the joint center of rotation offset in patients with instability due to soft tissue laxity. Humeral shortening and excessive glenoid medialization are the main problems in recurrence. In patients with humeral shortening without excessive glenoid medialization, the stability is ensured by one or more of the following: implementing a higher sized insert, metal heightener (spacer), longer cemented humeral stem, and a structural humeral bone graft. If a longer humeral stem comes up short, the stability is reexamined following changing the glenosphere with a higher sized or eccentric one. The glenoid offset is enhanced in patients with excessive glenoid medialization by lateralization or increasing the size of glenosphere and in those with glenoid defect by using bone grafts. The instability risk can be kept to minimum by choosing the most appropriate technique considering the implant design, placement of the components in anatomical position (height and version), avoiding any potential impingement, and adjusting the soft tissue tension by minimal damage.

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References

  1. Grammont PM, Baulot E. Delta shoulder prosthesis for rotator cuff rupture. Orthopedics. 1993;16:65–8.

    CAS  Google Scholar 

  2. Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br. 2010;92:535–9.

    CAS  PubMed  Google Scholar 

  3. Walker M, Willis MP, Brooks JP, Pupello D, Mulieri PJ, Frankle MA. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21:514–22.

    PubMed  Google Scholar 

  4. Young AA, Smith MM, Bacle G, Moraga C, Walch G. Early results of reverse shoulder arthroplasty in patients with rheumatoid arthritis. J Bone Joint Surg Am. 2011;93:1915–23.

    PubMed  Google Scholar 

  5. Chalmers PN, Rahman Z, Romeo AA, Nicholson GP. Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23:737–44.

    PubMed  Google Scholar 

  6. Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19:439–49.

    PubMed  Google Scholar 

  7. Clark JC, Ritchie J, Song FS, Kissenberth MJ, Tolan SJ, Hart ND, Hawkins RJ. Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis. J Shoulder Elbow Surg. 2012;21:36–41.

    PubMed  Google Scholar 

  8. Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011;20:146–57.

    PubMed  Google Scholar 

  9. Boileau P. Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res. 2016;102:S33–43.

    CAS  PubMed  Google Scholar 

  10. Walch G, Wall B, Mottier F. Complications and revision of the reverse prosthesis: a multicenter study of 457 cases. In: Walch G, Boileau P, Mole D, et al., editors. Reverse shoulder arthroplasty: clinical result, complications, revisions. Montpellier: Sauramps Medical; 2006. p. 335–52.

    Google Scholar 

  11. Teusink MJ, Pappou IP, Schwartz DG, Cottrell BJ, Frankle MA. Results of closed management of acute dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2015;24:621–7.

    PubMed  Google Scholar 

  12. Bacle G, Nové-Josserand L, Garaud P, Walch G. Long-term outcomes of reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2017;99:454–61.

    PubMed  Google Scholar 

  13. Aluisio FV, Osbahr DC, Speer KP. Analysis of rotator cuff muscles in adult human cadaveric specimens. Am J Orthop (Belle Mead NJ). 2003;32:124–9.

    Google Scholar 

  14. Gutierrez S, Keller TS, Levy JC, Lee WE, Luo ZP. Hierarchy of stability factors in reverse shoulder arthroplasty. Clin Orthop Relat Res. 2008;466:670–6.

    PubMed  PubMed Central  Google Scholar 

  15. Ladermann A, Lubbeke A, Collin P, Edwards TB, Sirveaux F, Walch G. Influence of surgical approach on functional outcome in reverse shoulder arthroplasty. Orthop Traumatol Surg Res. 2011;97(6):579–82.

    CAS  PubMed  Google Scholar 

  16. Clouthier AL, Hetzler MA, Fedorak G, Bryant JT, Deluzio KJ, Bicknell RT. Factors affecting the stability of reverse shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg. 2013;22(4):439–44.

    PubMed  Google Scholar 

  17. Mole D, Wein F, Dezaly C, Valenti P, Sirveaux F. Surgical technique: the anterosuperior approach for reverse shoulder arthroplasty. Clin Orthop Relat Res. 2011;469(9):2461–8.

    PubMed  PubMed Central  Google Scholar 

  18. Gallo RA, Gamradt SC, Mattern CJ, Cordasco FA, Craig EV, Dines DM, Warren R. Instability after reverse total shoulder replacement. J Shoulder Elbow Surg. 2011;20(4):584–90.

    PubMed  Google Scholar 

  19. Affonso J, Nicholson GP, Frankle MA, Walch G, Gerber C, Garzon-Muvdi J, et al. Complications of the reverse prosthesis: prevention and treatment. Instr Course Lect. 2012;61:157–68.

    PubMed  Google Scholar 

  20. Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14(Suppl S):147S–61S.

    PubMed  Google Scholar 

  21. Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O’Connor DP. Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18:892–6.

    PubMed  Google Scholar 

  22. Gerber C, Pennington SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009;17:284–95.

    PubMed  Google Scholar 

  23. Stephenson DR, Oh JH, McGarry MH, Rick Hatch GF, Lee TQ. Effect of humeral component version on impingement in reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20:652–8.

    PubMed  Google Scholar 

  24. Gutierrez S, Comiskey CA, Luo ZP, Pupello DR, Frankle MA. Range of impingement-free abduction and adduction deficit after reverse shoulder arthroplasty. Hierarchy of surgical and implant-design-related factors. J Bone Joint Surg Am. 2008;90:2606–15.

    PubMed  Google Scholar 

  25. De Wilde LF, Poncet D, Middernacht B, Ekelund A. Prosthetic overhang is the most effective way to prevent scapular conflict in a reverse total shoulder prosthesis. Acta Orthop. 2010;81:719–26.

    PubMed  PubMed Central  Google Scholar 

  26. Gutierrez S, Walker M, Willis M, Pupello DR, Frankle MA. Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model validated by a mechanical model of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2011;20:732–9.

    PubMed  Google Scholar 

  27. Ekelung AL. Complications of reverse total shoulder arthroplasty. In: Iannotli JP, Miniaci A, Williams GR, Zuckerman JD, editors. Disorders of the shoulder diagnosis and management: shoulder reconstruction. 3rd ed. Philadelphia, PA: Wolters Kluwer; 2014. p. 471–83.

    Google Scholar 

  28. Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae. And revision arthroplasty. J Shoulder Elbow Surg. 2006;15:527–40.

    PubMed  Google Scholar 

  29. Wierks C, Skolasky RL, Ji JH, McFarland EG. Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res. 2009;467:225–34.

    PubMed  Google Scholar 

  30. Lädermann A, Williams MD, Melis B, Hoffmeyer P, Walch G. Objective evaluation of lengthening in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18:588–95.

    PubMed  Google Scholar 

  31. Gerber C, Pennington SD, Lingenfelter EJ, Sukthankar A. Reverse delta-ill total shoulder replacement combined with latissimus dorsi transfer. J Bone Joint Surg Am. 2007;89(5):940–7.

    PubMed  Google Scholar 

  32. Turkel SJ, Panio IMW, Marshall JL. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg Am. 1981;63:1208–17.

    CAS  PubMed  Google Scholar 

  33. Pappou JP, Teusink MJ, Frankle MA. Dislocation and instability in reverse shoulder arthroplasty: biomechanics, prevention, review of the literature, and management. In: Dodson CC, Dines DM, Dines JS, Walch G, Williams GR, editors. Controversies in shoulder instability. Philadelphia, PA: Wolters Kluwer; 2014. p. 377–91.

    Google Scholar 

  34. Trappey GJ, O’Connor DP, Edwards TB. What are the instability and infection rates after reverse shoulder arthroplasty? Clin Orthop Relat Res. 2011;469:2505–11.

    PubMed  Google Scholar 

  35. Wall B, Nave-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89:1476–85.

    PubMed  Google Scholar 

  36. Padegimas EM, Zmistowski B, Restrepo C, Abboud JA, Lazarus MD, Ramsey ML, Williams GR, Namdari S. Instability after reverse total shoulder arthroplasty: which patients dislocate? Am J Orthop (Belle Mead NJ). 2016;45(7):444–50.

    Google Scholar 

  37. Naveed MA, Kitson J, Bunker TD. The Delta III reverse shoulder replacement for cuff tear arthropathy: a single Centre study of 50 consecutive procedures. J Bone Joint Surg Br. 2011;93:57–61.

    CAS  PubMed  Google Scholar 

  38. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gaber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89:588–600.

    PubMed  Google Scholar 

  39. Seebauer L. Reverse shoulder arthroplasty in the management of glenohumeral arthritis and irreparable cuff insufficiency. In: Iannotli JP, Miniaci A, Williams GR, Zuckerman JD, editors. Disorders of the shoulder diagnosis and management: shoulder reconstruction. 3rd ed. Philadelphia, PA: Wolters Kluwer; 2014. p. 403–34.

    Google Scholar 

  40. Werner CM, Steinmann PA, Gilban M, Gerber C. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am. 2005;87:1476–86.

    CAS  PubMed  Google Scholar 

  41. Pastor MF, Kraemer M, Wellmann M, Hurschler C, Smith T. Anterior stability of the reverse shoulder arthroplasty depending on implant configuration and rotator cuff condition. Arch Orthop Trauma Surg. 2016;136:1513–9.

    PubMed  Google Scholar 

  42. Kohan EM, Chalmers PN, Salazar D, Keener JD, Yamaguchi K, Chamberlain AM. Dislocation following reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(7):1238–45.

    PubMed  Google Scholar 

  43. Barco R, Savvidou OD, Sperling JW, Sotelo JS, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev. 2016;1:72–80.

    PubMed  PubMed Central  Google Scholar 

  44. Chacon A, Virani N, Shannon R, Levy JC, Pupello D, Frankle M. Revision arthroplasty with use of a reverse shoulder prosthesis allograft composite. J Bone Joint Surg Am. 2009;91:119–27.

    PubMed  Google Scholar 

  45. Elhassan B, Ozbaydar M, Massimini D, Diller D, Higgins L, Warner JP. Transfer of pectoralis major for the treatment of irreparable tears of subscapularis. J Bone Joint Surg (Br). 2008;90(8):1059–65.

    CAS  Google Scholar 

  46. Hamid N, Galatz LM. Techniques for revision arthroplasty: management of bone and soft tissue loss. In: Iannotli JP, Miniaci A, Williams GR, Zuckerman JD, editors. Disorders of the shoulder diagnosis and management: shoulder reconstruction. 3rd ed. Philadelphia, PA: Wolters Kluwer; 2014. p. 484–504.

    Google Scholar 

  47. Favre P, Sussmann PS, Gerber C. The effect of component positioning on intrinsic stability of the reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19:550–6.

    PubMed  Google Scholar 

  48. Randelli P, Randelli F, Arrigoni P, Ragone V, D’Ambrosi R, Masuzzo P, Cabitza P, Banfi G. Optimal glenoid component inclination in reverse shoulder arthroplasty. How to improve implant stability. Musculoskelet Surg. 2014;98(Suppl 1):S15–8.

    Google Scholar 

  49. Boileau P, Melis B, Duperron D, Moineau G, Rumian AP, Han Y. Revision surgery of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2013;22:1359–70.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey

    Mustafa Özer

  2. Department of Orthopaedics and Traumatology, Mengucek Gazi Training and Research Hospital, Erzincan University, Erzincan, Turkey

    Mehmet Çetinkaya

  3. Department of Orthopaedics and Traumatology, Gazi University School of Medicine, Ankara, Turkey

    Ulunay Kanatlı

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  1. Mustafa Özer
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  2. Mehmet Çetinkaya
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  3. Ulunay Kanatlı
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Editor information

Editors and Affiliations

  1. Orthopaedics & Traumatology, Hacettepe University School of Medicine Orthopaedics & Traumatology, Ankara, Turkey

    Gazi Huri

  2. Department of Orthopedic Surgery, Villa del Sole Clinic and Magna Graecia University of Catanzaro, Catanzaro, Italy

    Filippo Familiari

  3. Orthopedic Department, Chosun University Hospital Orthopedic Department, Gwangju, Korea (Republic of)

    Young Lae Moon

  4. Department of Orthopedics & Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Mahmut Nedim Doral

  5. II Clinica Ortopedica & Laboratory Biomeccanica, IRCCS Istituto Ortopedico Rizzoli - University of Bologna, Bologna, Italy

    Giulio Maria Marcheggiani Muccioli

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Özer, M., Çetinkaya, M., Kanatlı, U. (2020). Unstable Reverse Total Shoulder Arthroplasty: How to Avoid and Manage. In: Huri, G., Familiari, F., Moon, Y.L., Doral, M.N., Marcheggiani Muccioli, G.M. (eds) Shoulder Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-19285-3_7

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  • DOI: https://doi.org/10.1007/978-3-030-19285-3_7

  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-19285-3

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