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Converting to reverse shoulder arthroplasty from primary anatomic shoulder arthroplasty and fracture hemiarthroplasty: a radiographic and clinical outcome analysis at 8-years

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Revision shoulder arthroplasty can be challenging. One of the main considerations for surgeons is the type of implant that was placed in the initial surgery. Anatomic shoulder arthroplasty (ASA) is used for cases of osteoarthritis as well as for fractures of the humeral head. Hemiarthroplasty can be used for complex proximal humerus fractures. The purpose of this study is to determine whether there is a difference in clinical and radiographic outcomes between patients that failed primary fracture hemiarthroplasty (FHA), or ASA for osteoarthritis and then required reoperation with a conversion to reverse shoulder arthroplasty (RSA).

Methods

Patients with failed anatomic shoulder replacement, who had undergone conversion to RSA, were enrolled after a mean follow-up of 107 (85–157) months. Two different groups, one with failed ASA implanted for osteoarthritis and one with failed FHA, were created. At follow-up patients were assessed with standard radiographs and clinical outcome scores.

Results

Twenty-nine patients (f = 17, m = 12; 51%) suffered from a failed ASA (Group A), while the remaining 28 patients (f = 21, m = 74; 49%) had been revised due to a failed FHA (Group B). Patients of Group B had a poorer Constant score (Group A: 60 vs. Group B: 46; p = 0.02). Abduction (Group A: 115° vs. Group B: 89°; p = 0.02) was worse after conversion of a failed FHA to RSA in comparison to conversions of failed ASA.

The mean bone loss of the lateral metaphysis was higher in patients with failed FHA (Group A: 5 mm vs. Group B: 20 mm; p = 0.0).

Conclusion

The initial indication for anatomic shoulder arthroplasty influences the clinical and radiological outcome after conversion to RSA. Conversion of failed FHA to RSA is related to an increased metaphyseal bone loss, decreased range of motion and poorer clinical outcomes when compared to conversions of failed ASA implanted for osteoarthritis.

Level of Evidence

III Retrospective Cohort Comparison Study.

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References

  1. Alrabaa RG, Ma G, Truong NM, Lansdown DA, Feeley BT, Zhang AL, Ma CB (2022) Trends in surgical treatment of proximal humeral fractures and analysis of postoperative complications over a decade in 384,158 patients. JBJS Open Access 7(4):22

    Article  Google Scholar 

  2. Austin L, Zmistowski B, Chang ES, Williams GR Jr (2011) Is reverse shoulder arthroplasty a reasonable alternative for revision arthroplasty? Clin Orthop Relat Res 469(9):2531–2537

    Article  PubMed  Google Scholar 

  3. Bartels DW, Marigi E, Sperling JW, Sanchez-Sotelo J (2021) Revision reverse shoulder arthroplasty for anatomical glenoid component loosening was not universally successful: a detailed analysis of 127 consecutive shoulders. J Bone Joint Surg Am 103(10):879–886

    Article  PubMed  Google Scholar 

  4. Bonnevialle N, Tournier C, Clavert P et al (2016) Hemiarthroplasty versus reverse shoulder arthroplasty in 4-part displaced fractures of the proximal humerus: multicenter retrospective study. Orthop Traumatol Surg Res 102(5):569–573

    Article  CAS  PubMed  Google Scholar 

  5. Dines JS, Fealy S, Strauss EJ et al (2006) Outcomes analysis of revision total shoulder replacement. J Bone Joint Surg Am 88(7):1494–1500

    Article  PubMed  Google Scholar 

  6. Flury MP, Frey P, Goldhahn J, Schwyzer HK, Simmen BR (2011) Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure–midterm results. Int Orthop 35(1):53–60

    Article  PubMed  Google Scholar 

  7. Gohlke F, Rolf O (2007) Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the transhumeral approach : method incorporating a pectoralis-major-pedicled bone window. Oper Orthop Traumatol 19(2):185–208

    Article  PubMed  Google Scholar 

  8. Hao KA, Boschert EN, O’Keefe DS et al (2023) Comparison of clinical outcomes of revision reverse total shoulder arthroplasty for failed primary anatomic vs. reverse shoulder arthroplasty. JSES Int 7(2):257–263

    Article  PubMed  Google Scholar 

  9. Hao KA, Hones KM, O’Keefe DS, Saengchote SA, Burns MQ, Wright JO, King JJ (2023) Quantifying success after first revision reverse total shoulder arthroplasty: the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state. J Shoulder Elbow Surg 32(10):516–527

    Article  Google Scholar 

  10. Holschen M, Franetzki B, Witt KA, Liem D, Steinbeck J (2017) Conversions from anatomic shoulder replacements to reverse total shoulder arthroplasty: do the indications for initial surgery influence the clinical outcome after revision surgery? Arch Orthop Trauma Surg 137(2):167–172

    Article  PubMed  Google Scholar 

  11. Holschen M, Siemes MK, Witt KA, Steinbeck J (2018) Five-year outcome after conversion of a hemiarthroplasty when used for the treatment of a proximal humeral fracture to a reverse total shoulder arthroplasty. Bone Joint J 100(B6):761–766

    Article  PubMed  Google Scholar 

  12. Kelly JD 2nd, Zhao JX, Hobgood ER, Norris TR (2012) Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg 21(11):1516–1525

    Article  PubMed  Google Scholar 

  13. Kew ME, Mathew JI, Moran J et al (2023) Factors associated with humeral stem revision in anatomic to reverse total shoulder arthroplasty revision. J Should Elbow Surg 32(9):1867–1875

    Article  Google Scholar 

  14. Levy J, Frankle M, Mighell M, Pupello D (2007) The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am 89(2):292–300

    Article  PubMed  Google Scholar 

  15. Levy JC, Virani N, Pupello D, Frankle M (2007) Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg Br 89(2):189–195

    Article  CAS  PubMed  Google Scholar 

  16. Merolla G, D’Ambrosi R, Buda M et al (2023) What to expect after revision shoulder arthroplasty? A comprehensive review of the literature. Acta Biomed 94(S2):e2023145

    PubMed  Google Scholar 

  17. O’Keefe DS, Hao KA, Teurlings TL et al (2023) Survivorship analysis of revision reverse total shoulder arthroplasty. J Shoulder Elbow Surg 32(7):e343–e354

    Article  PubMed  Google Scholar 

  18. Ortmaier R, Resch H, Matis N et al (2013) Reverse shoulder arthroplasty in revision of failed shoulder arthroplasty-outcome and follow-up. Int Orthop 37(1):67–75

    Article  PubMed  Google Scholar 

  19. Patel DN, Young B, Onyekwelu I, Zuckerman JD, Kwon YW (2012) Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elbow Surg 21(11):1478–1483

    Article  PubMed  Google Scholar 

  20. Postacchini R, Castagna A, Borroni M, Cinotti G, Postacchini F, Gumina S (2012) Total shoulder arthroplasty for the treatment of failed hemiarthroplasty in patients with fracture of the proximal humerus. J Shoulder Elbow Surg 21(11):1542–1549

    Article  PubMed  Google Scholar 

  21. Reddy AK, Checketts JX, Stephens BJ et al (2022) Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review. Shoulder Elbow 14(5):481–490

    Article  PubMed  Google Scholar 

  22. Rosas S, Law TY, Kurowicki J, Formaini N, Kalandiak SP, Levy JC (2016) Trends in surgical management of proximal humeral fractures in the medicare population: a nationwide study of records from 2009 to 2012. J Shoulder Elbow Surg 25(4):608–613

    Article  PubMed  Google Scholar 

  23. Sebastia-Forcada E, Cebrian-Gomez R, Lizaur-Utrilla A, Gil-Guillen V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded randomized controlled prospective study. J Shoulder Elbow Surg 23(10):1419–1426

    Article  PubMed  Google Scholar 

  24. Shukla DR, McAnany S, Kim J, Overley S, Parsons BO (2016) Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elbow Surg 25(2):330–340

    Article  PubMed  Google Scholar 

  25. Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Mole D (2004) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 86(3):388–395

    Article  CAS  PubMed  Google Scholar 

  26. Trappey GJ, O’Connor DP, Edwards BT (2011) What are the instability and infection rates after reverse shoulder arthroplasty? Clin Orthop Relat Res 469(9):2505–2511

    Article  PubMed  Google Scholar 

  27. Wang J, Zhu Y, Zhang F, Chen W, Tian Y, Zhang Y (2016) Meta-analysis suggests that reverse shoulder arthroplasty in proximal humerus fractures is a better option than hemiarthroplasty in the elderly. Int Orthop 40(3):531–539

    Article  PubMed  Google Scholar 

  28. Yian EH, Ramappa AJ, Arneberg O, Gerber C (2005) The Constant score in normal shoulders. J Shoulder Elbow Surg 14(2):128–133

    Article  PubMed  Google Scholar 

  29. Zhao Y, Zhu Y, Lu Y, Li F, Jiang C (2023) Long-term outcomes of shoulder hemiarthroplasty for acute proximal humeral fractures. Int Orthop 47(6):1517–1526

    Article  PubMed  Google Scholar 

  30. Zumstein MA, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20(1):146–157

    Article  PubMed  Google Scholar 

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Author notes

  1. Malte Holschen and Yacine Amaziane have contributed equally to this study.

Authors and Affiliations

  1. Orthopedic Practice Clinic (OPPK), Schuerbusch 55, 48143, Münster, Germany

    Malte Holschen, Yacine Amaziane, Lisa Meyer & Jörn Steinbeck

  2. Department of Orthopedics and Trauma Surgery, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany

    Benjamin Bockmann & Tobias L. Schulte

  3. Banner University Medical Group, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

    Youssef Galal

Authors
  1. Malte Holschen
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  2. Yacine Amaziane
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  3. Lisa Meyer
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  4. Youssef Galal
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Correspondence to Malte Holschen.

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Conflict of interest

Yacine Ameziane, Youssef Galal, Lisa Meyer, Benjamin Bockmann, Malte Holschen and Tobias L. Schulte have no conflicts of interest. Jörn Steinbeck receives payments from Arthrex Inc. for lectures and instructional courses.

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Holschen, M., Amaziane, Y., Meyer, L. et al. Converting to reverse shoulder arthroplasty from primary anatomic shoulder arthroplasty and fracture hemiarthroplasty: a radiographic and clinical outcome analysis at 8-years. Eur J Orthop Surg Traumatol 34, 2193–2200 (2024). https://doi.org/10.1007/s00590-024-03916-8

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