Top

Published in:

01-07-2017 | Original Article

Functional Outcomes of Modular Conversion of Hemiarthroplasty or Total to Reverse Total Shoulder Arthroplasty

Authors: Phillip N. Williams, MD, Samir K. Trehan, MD, Nicholas Tsouris, BA, Joshua S. Dines, MD, David M. Dines, MD, Edward V. Craig, MD, MPH, Lawrence V. Gulotta, MD, Russell F. Warren, MD

Published in: HSS Journal ® | Issue 2/2017

Abstract

Background

The advent of modular shoulder arthroplasty systems has allowed the conversion of hemiarthroplasty or total shoulder arthroplasty to reverse total shoulder arthroplasty (RTSA) without removing a well-fixed stem.

Questions/Purposes

To determine the feasibility, functional outcome, and complication profile of RTSA modular conversion.

Methods

A prospective shoulder arthroplasty registry was queried for consecutive patients scheduled for a modular conversion from January 1, 2007, to April 1, 2015. Eligible patients had medical charts and operative records reviewed for preoperative diagnosis, age, medical comorbidities, preoperative American Shoulder and Elbow Society (ASES) score, preoperative Visual Analogue Scale (VAS) pain and instability scores, and intraoperative findings. Each patient was then contacted by telephone or mail to complete up-to-date ASES and VAS questionnaires.

Results

Seventeen patients underwent a modular conversion. Nine patients were scheduled for modular conversion but underwent humeral revision due to excessive soft tissue tension (65.3% modular conversion rate). Average follow-up was 37.4 months (range 10.0–67.6 months). Pain scores improved from 5.3 (range 0.4 to 8.0) to 2.4 (range 0 to 9.3) (p < 0.01), instability VAS from 5.2 (range 0 to 10) to 1.1 (range 0 to 6.8) (p < 0.01), and ASES scores improved from 35.2 (range 20.7 to 61.3) to 65.6 (range 11.8 to 92) (p < 0.01).

Conclusions

Modular conversion of an anatomic to a RTSA is feasible in a majority of patients. Despite the complexity of the procedure, modular conversion of hemiarthroplasty or TSA to RTSA can significantly improve functional outcomes with a low rate of complications.

Available only for authorised users

Black EM, Roberts SM, Siegel E, Yannopoulos P, Higgins LD, Warner JJP. Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65years of age or younger. J Shoulder Elb Surg. 2014; 23(7): 1036-1042. doi:10.1016/j.jse.2014.02.019.CrossRef

Bohsali KI, Wirth MA, Rockwood CA. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006; 88(10): 2279-2292. doi:10.2106/JBJS.F.00125.PubMed

Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. 2005 Jan;14(1 Suppl S):147S–161S. doi:10.1016/j.jse.2004.10.006.

Chuinard C. CORR Insights®: conversion of stemmed hemi- or total to reverse total shoulder arthroplasty: advantages of a modular stem design. Clin Orthop Relat Res. 2014; 473(2): 661-662. doi:10.1007/s11999-014-4043-6.CrossRefPubMedPubMedCentral

Fenlin JM, Ramsey ML, Allardyce TJ, Frieman BG. Modular total shoulder replacement. Design rationale, indications, and results. Clin Orthop Relat Res. 1994; 307: 37-46.

Flury MP, Frey P, Goldhahn J, Schwyzer H-K, Simmen BR. Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure--midterm results. Int Orthop. 2011; 35(1): 53-60. doi:10.1007/s00264-010-0990-z.CrossRefPubMed

Gartsman GM, Roddey TS, Hammerman SM. Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis. J Bone Joint Surg Am. 2000; 82(1): 26-34.CrossRefPubMed

Giuseffi SA, Wongtriratanachai P, Omae H, et al. Biomechanical comparison of lesser tuberosity osteotomy versus subscapularis tenotomy in total shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21(8): 1087-1095. doi:10.1016/j.jse.2011.07.008.CrossRefPubMed

Gohlke F, Rolf O. [Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the transhumeral approach: method incorporating a pectoralis-major-pedicled bone window]. Operative Orthop\"adie und Traumatologie. 2007; 19(2): 185-208. doi:10.1007/s00064-007-1202-x.CrossRef

10.

Gonzalez J-F, Alami GB, Baque F, Walch G, Boileau P. Complications of unconstrained shoulder prostheses. J Shoulder Elb Surg. 2011; 20(4): 666-682. doi:10.1016/j.jse.2010.11.017.CrossRef

11.

Guery J, Favard L, Sirveaux FCO, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am. 2006; 88(8): 1742-1747. doi:10.2106/JBJS.E.00851.PubMed

12.

Gutiérrez S, Keller TS, Levy JC, Lee WE III, Luo Z-P. Hierarchy of Stability Factors in Reverse Shoulder Arthroplasty. Clin Orthop Relat Res. 2008; 466(3): 670-676. doi:10.1007/s11999-007-0096-0.CrossRefPubMedPubMedCentral

13.

13. Hasan SS, Leith JM, Campbell B, Kapil R, Kapil c R, Smith KL, et al. Characteristics of unsatisfactory shoulder arthroplasties. 2002 Sep;11(5):431–441.

14.

Jandhyala S, Unnithan A, Hughes S, Hong T. Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes. J Shoulder Elbow Surg. 2011; 20(7): 1102-1107. doi:10.1016/j.jse.2011.03.019.CrossRefPubMed

15.

Lapner PLC, Sabri E, Rakhra K, Bell K, Athwal GS. Healing rates and subscapularis fatty infiltration after lesser tuberosity osteotomy versus subscapularis peel for exposure during shoulder arthroplasty. J Shoulder Elbow Surg. 2013; 22(3): 396-402. doi:10.1016/j.jse.2012.05.031.CrossRefPubMed

16.

Lapner PLC, Sabri E, Rakhra K, Bell K, Athwal GS. Comparison of lesser tuberosity osteotomy to subscapularis peel in shoulder arthroplasty: a randomized controlled trial. J Bone Joint Surg. 2012; 94(24): 2239-2246. doi:10.2106/JBJS.K.01365.CrossRefPubMed

17.

Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007; 89(2): 292-300. doi:10.2106/JBJS.E.01310.PubMed

18.

Lo IKY, Litchfield RB, Griffin S, Faber K, Patterson SD, Kirkley A. Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. A prospective, randomized trial. J Bone Joint Surg Am. 2005; 87(10): 2178-2185. doi:10.2106/JBJS.D.02198.PubMed

19.

Melis B, Bonnevialle N, Neyton L. L e vigne C, Favard L, Walch G, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elbow Surg. 2012; 21(3): 342-349. doi:10.1016/j.jse.2011.05.021.CrossRefPubMed

20.

Mighell MA, Kolm GP, Collinge CA, Frankle MA. Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Shoulder Elb Surg. 2003; 12(6): 569-577. doi:10.1016/S1058274603002131.CrossRef

21.

Miller BS, Joseph TA, Noonan TJ, Horan MP, Hawkins RJ. Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome. J Shoulder Elb Surg. 2005; 14(5): 492-496. doi:10.1016/j.jse.2005.02.013.CrossRef

22.

Moeckel BH, Altchek DW, Warren RF, Wickiewicz TL, Dines DM. Instability of the shoulder after arthroplasty. J Bone Joint Surg Am. 1993; 75(4): 492-497.CrossRefPubMed

23.

Sperling JW, Hawkins RJ, Walch G, Zuckerman JD. Complications in Total Shoulder Arthroplasty. J Bone Joint Surg Am. 2013; 95(6): 563-569.CrossRefPubMed

24.

Teschner H, Albrecht U-V, Meller R, et al. Conversion of hemi into reverse shoulder arthroplasty: implant design limitations. Arch Orthop Trauma Surg. 2014; 134(12): 1683-1689. doi:10.1007/s00402-014-2098-1.CrossRefPubMed

25.

Wall B, Nove 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(7): 1476-1485. doi:10.2106/JBJS.F.00666.PubMed

26.

Werner BS, Boehm D, Gohlke F. Revision to reverse shoulder arthroplasty with retention of the humeral component. Acta Orthop. 2013; 84(5): 473-478. doi:10.3109/17453674.2013.842433.CrossRefPubMedPubMedCentral

27.

Wieser K, Borbas P, Ek ET, Meyer DC, Gerber C. Conversion of stemmed hemi- or total to reverse total shoulder arthroplasty: advantages of a modular stem design. Clin Orthop Relat Res. 2014; 473(2): 651-660. doi:10.1007/s11999-014-3985-z.CrossRefPubMedPubMedCentral

28.

Young AA, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up. J Bone Joint Surg. 2012; 94(8): 685-693. doi:10.2106/JBJS.J.00727.CrossRefPubMed

Title: Functional Outcomes of Modular Conversion of Hemiarthroplasty or Total to Reverse Total Shoulder Arthroplasty
Authors: Phillip N. Williams, MD
Samir K. Trehan, MD
Nicholas Tsouris, BA
Joshua S. Dines, MD
David M. Dines, MD
Edward V. Craig, MD, MPH
Lawrence V. Gulotta, MD
Russell F. Warren, MD
Publication date: 01-07-2017
Publisher: Springer US
Published in: HSS Journal ® / Issue 2/2017
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI: https://doi.org/10.1007/s11420-017-9546-8

At a glance: The STEP trials

Springer Medicine

Functional Outcomes of Modular Conversion of Hemiarthroplasty or Total to Reverse Total Shoulder Arthroplasty

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/Purposes

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2017

Open Wedge Distal Femoral Osteotomy: Accuracy of Correction and Patient Outcomes

Propionibacterium acnes Host Inflammatory Response During Periprosthetic Infection Is Joint Specific

Ankle Reconstruction in Fibular Hemimelia: New Approach

Thrombotic and Infectious Morbidity Are Associated with Transfusion in Posterior Spine Fusion

Lung Adenocarcinoma with Miliary Metastases and Left Femur Pathologic Fracture: an Unusual Case Mimicking Disseminated Tuberculosis

Bone Mineral Density Response from Teriparatide in Patients with Osteoporosis