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Delta Reverse Polarity Shoulder Replacement: Single Surgeon Experience with a Minimum 2-Year Follow-up.

Jehan S, Eltayeb M, Javaid MM - Clin Orthop Surg (2015)

Bottom Line: A single surgeon performed all procedures using the anterosuperior approach.The improvement in the Constant score was significant (p < 0.001).At this stage, the results are encouraging with no cases of loosening, dislocation, or nerve injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedic Surgery, Diana Princess of Wales Hospital, Grimsby, UK.

ABSTRACT

Background: The delta reverse shoulder replacement system was developed for the treatment of rotator cuff arthropathy so that the deltoid can substitute for the deficient rotator cuff. To evaluate the results of delta reverse shoulder replacement for functional improvement and complications in a consecutive series by a single surgeon over a period of six years with a minimum follow-up of 2 years.

Methods: The data were collected retrospectively from electronic theatre records. Over a period of 6 years (2006-2012), 46 cases that fulfilled the inclusion criteria were identified. There were 34 females and 12 males. The average age of patients was 76.2 years (range, 58 to 87 years). A single surgeon performed all procedures using the anterosuperior approach. The mean follow-up time was 49 months (range, 24 to 91 months). All cases had preoperative and postoperative Constant scores. We collected the data on indications, hospital stay, and change in the Constant score, complications, and reoperation rates.

Results: The main indication for surgery was rotator cuff arthropathy (52.2%), followed by massive rotator cuff tear (28.3%), osteoarthritis (8.7%), fractures (6.5%), and rheumatoid arthritis (4.3%). Also, 65.2% of the cases were referred by general practitioners, 26% of the cases were referred by other consultants, and 8.8% of the cases were already under the care of a shoulder surgeon. The average preoperative Constant score was 23.5 (range, 8 to 59). The average Constant score at the final follow-up was 56 (range, 22 to 83). On average, there was an improvement of 33 points in the Constant score. The improvement in the Constant score was significant (p < 0.001). We observed complications in four patients (8.6%). Three of four patients (6.5%) needed reoperation. The first complication was pulmonary embolism in the early postoperative period. The other complications included dissociation of the glenosphere from the metaglene, deltoid detachment, and stitch abscess.

Conclusions: This is a single-surgeon, single-approach series of 46 cases with a minimum follow-up of 2 years. At this stage, the results are encouraging with no cases of loosening, dislocation, or nerve injury.

No MeSH data available.


Related in: MedlinePlus

Disengagement of glenosphere. Radiograph (A) and fluoroscopic image (B) of the left shoulder obtained during manipulation under anesthesia. The arrows show dissociated glenosphere from the metaglene.
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Figure 3: Disengagement of glenosphere. Radiograph (A) and fluoroscopic image (B) of the left shoulder obtained during manipulation under anesthesia. The arrows show dissociated glenosphere from the metaglene.

Mentions: We observed complications in 4 patients (8.6%). Table 2 shows the nature and timing of complications. The first complication was pulmonary embolism in the early postoperative period. This patient was treated with warfarin. The second patient experienced pain and sound in his shoulder 6 months after the surgery. His radiographs raised the suspicion of dissociation between the glenosphere and the metaglene. Examination under anaesthesia using image intensifier confirmed the dissociation of the glenosphere from the metaglene (Fig. 3). This patient required revision surgery. Intraoperatively, it was noted that the screw on the medial surface of the glenosphere was broken. The movement of the glenosphere had caused damage of the polyethylene (Fig. 4). The metaglene, the glenosphere, and the polyethylene were revised. The next complication was a stitch abscess, which was observed at 5 weeks after surgery. The abscess was drained. However, 5 months after the initial surgery, the patient developed a sinus at the site of the stitch abscess. The sinus covered with the granulation tissue was excised. The patient did not require any further procedures. The final complication was detachment of the deltoid muscle. This patient had undergone previous open subacromial decompression and rotator cuff repair at another hospital. His preoperative X-rays showed fracture of the acromion. During arthroplasty, it was noted that he had fibrous non-union of the acromion, but the deltoid muscle was in good shape. Therefore, the acromion fracture was left alone and arthroplasty was performed. Postoperatively, he experienced pain and X-rays showed that the fracture fragment was pulled by the deltoid (Fig. 5). This patient required surgery for re-attaching the deltoid muscle. In total, we had three patients who needed reoperation for any reason. Among these patients, only one patient had prosthesis failure.


Delta Reverse Polarity Shoulder Replacement: Single Surgeon Experience with a Minimum 2-Year Follow-up.

Jehan S, Eltayeb M, Javaid MM - Clin Orthop Surg (2015)

Disengagement of glenosphere. Radiograph (A) and fluoroscopic image (B) of the left shoulder obtained during manipulation under anesthesia. The arrows show dissociated glenosphere from the metaglene.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553285&req=5

Figure 3: Disengagement of glenosphere. Radiograph (A) and fluoroscopic image (B) of the left shoulder obtained during manipulation under anesthesia. The arrows show dissociated glenosphere from the metaglene.
Mentions: We observed complications in 4 patients (8.6%). Table 2 shows the nature and timing of complications. The first complication was pulmonary embolism in the early postoperative period. This patient was treated with warfarin. The second patient experienced pain and sound in his shoulder 6 months after the surgery. His radiographs raised the suspicion of dissociation between the glenosphere and the metaglene. Examination under anaesthesia using image intensifier confirmed the dissociation of the glenosphere from the metaglene (Fig. 3). This patient required revision surgery. Intraoperatively, it was noted that the screw on the medial surface of the glenosphere was broken. The movement of the glenosphere had caused damage of the polyethylene (Fig. 4). The metaglene, the glenosphere, and the polyethylene were revised. The next complication was a stitch abscess, which was observed at 5 weeks after surgery. The abscess was drained. However, 5 months after the initial surgery, the patient developed a sinus at the site of the stitch abscess. The sinus covered with the granulation tissue was excised. The patient did not require any further procedures. The final complication was detachment of the deltoid muscle. This patient had undergone previous open subacromial decompression and rotator cuff repair at another hospital. His preoperative X-rays showed fracture of the acromion. During arthroplasty, it was noted that he had fibrous non-union of the acromion, but the deltoid muscle was in good shape. Therefore, the acromion fracture was left alone and arthroplasty was performed. Postoperatively, he experienced pain and X-rays showed that the fracture fragment was pulled by the deltoid (Fig. 5). This patient required surgery for re-attaching the deltoid muscle. In total, we had three patients who needed reoperation for any reason. Among these patients, only one patient had prosthesis failure.

Bottom Line: A single surgeon performed all procedures using the anterosuperior approach.The improvement in the Constant score was significant (p < 0.001).At this stage, the results are encouraging with no cases of loosening, dislocation, or nerve injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedic Surgery, Diana Princess of Wales Hospital, Grimsby, UK.

ABSTRACT

Background: The delta reverse shoulder replacement system was developed for the treatment of rotator cuff arthropathy so that the deltoid can substitute for the deficient rotator cuff. To evaluate the results of delta reverse shoulder replacement for functional improvement and complications in a consecutive series by a single surgeon over a period of six years with a minimum follow-up of 2 years.

Methods: The data were collected retrospectively from electronic theatre records. Over a period of 6 years (2006-2012), 46 cases that fulfilled the inclusion criteria were identified. There were 34 females and 12 males. The average age of patients was 76.2 years (range, 58 to 87 years). A single surgeon performed all procedures using the anterosuperior approach. The mean follow-up time was 49 months (range, 24 to 91 months). All cases had preoperative and postoperative Constant scores. We collected the data on indications, hospital stay, and change in the Constant score, complications, and reoperation rates.

Results: The main indication for surgery was rotator cuff arthropathy (52.2%), followed by massive rotator cuff tear (28.3%), osteoarthritis (8.7%), fractures (6.5%), and rheumatoid arthritis (4.3%). Also, 65.2% of the cases were referred by general practitioners, 26% of the cases were referred by other consultants, and 8.8% of the cases were already under the care of a shoulder surgeon. The average preoperative Constant score was 23.5 (range, 8 to 59). The average Constant score at the final follow-up was 56 (range, 22 to 83). On average, there was an improvement of 33 points in the Constant score. The improvement in the Constant score was significant (p < 0.001). We observed complications in four patients (8.6%). Three of four patients (6.5%) needed reoperation. The first complication was pulmonary embolism in the early postoperative period. The other complications included dissociation of the glenosphere from the metaglene, deltoid detachment, and stitch abscess.

Conclusions: This is a single-surgeon, single-approach series of 46 cases with a minimum follow-up of 2 years. At this stage, the results are encouraging with no cases of loosening, dislocation, or nerve injury.

No MeSH data available.


Related in: MedlinePlus