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Stemless Reverse Total Shoulder Arthroplasty Surgical Technique and 10 Years Results

February 19, 2016

Contributors: Ofer Levy, MD

INTRODUCTION: Reverse shoulder replacements are gaining popularity in recent years with good results. However, high complication rate, high incidence of glenoid notching, and significant reoperation rate are of concern. Revision surgery poses a potential serious problem in stem removal. We have been using a novel design of stemless triple-finned reverse prosthesis that differs from all other known implants. We describe the surgical technique for this reverse total shoulder arthroplasty (TSA) - step by step and report 10 years results with this bone preserving reverse prosthesis with metaphyseal fixation. Tips and tricks to make reverse TSA surgery more simple with better outcome are presented.

METHODS: Between 2005 to 2014, 275 patients were operated for severe cuff deficiency and arthritis with stemless reverse total shoulder prosthesis. The mean age at surgery was 74.4y (range 38-93y). The aetiology for surgery was cuff arthropathy, fracture sequelae, Rheumatoid arthritis, failed RC repair, revision for loosening of anatomical prosthesis or for cuff failure with anatomic prostheses, and for acute trauma.

RESULTS: Patients had good pain relief and high satisfaction score, with significant improvement of function and Constant score. The mean range of movement improved to 128.5° elevation, 50.8° external rotation and 64.6° Internal rotation.

DISCUSSION AND CONCLUSION: This different design, without stem, shows encouraging excellent mid-term results with excellent pain relief and restoration of good active range of motion and good shoulder function. Significant improvement in patients' satisfaction score. The new design principles seem to result in low incidence of glenoid notching and improved rotational movements with return to full activities including sports. Radiologic assessment showed only 21% of mild glenoid notching, no lucencies around the implants and no signs of stress shielding or subsidence. With this stemless bone preserving procedure, all options remain open for future surgery if deemed necessary as bone stock is preserved and therefore this prosthesis may be used in younger patients as well.

Results for "Arthroplasty"

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