Abstract
Introduction
the aim of the study is to evaluate the clinical results of the shoulder prosthesis revision procedure to reverse implant without removing the humeral stem using a modular system (Lima LTD) and determine if this procedure is beneficial for the patients.
Methods
e selected only the patients where a revision to reverse (RSA) of hemiarthroplasty (Hemi) originally implanted for fracture (Group I) and revision to reverse (RSA) of anatomical total prosthesis (TSA) were performed. From 2004 to 2009 26 cases responding to these parameters were identified: 18 cases in Group I (failed hemiarthroplasty for tuberosities resorptions or rotator cuff failure) and 8 in Group II (failed TSA for rotator cuff omplication).
The mean follow-up was 32 months (min 18–max 76) and the mean age was 72 (min 65–max 80)
Clinical assessment was performed with preoperative and postoperative Constant score rating scale (CS) and range of motion evaluation (ROM)
Radiological assessment was performer by AP and Axial X-ray views. Operative time was calculated.
Results
overall pre-op CS was 24 (min 18–max 30), post-op CS was 47,8 (min 35–max 60).
In Group I the mean improvement of CS was 25,3; in Group II was 17.
All patients had a clinical improvement of the range of motion.
X-Rays study did not show radiolucent lines related to implant mobilization.
No major complications were observed in all the cases.
Discussion and Conclusion
Revision surgery for failed Hemi or TSA is commonly related to a relatively increase of complication and/or poorer out come if compared to a primary RSA implant.
Our study results demonstrate that using a full modular system from the first implant allows to skip the humeral stem removal/reimplant step in case of conversion of a shoulder prosthesis to a reverse with good clinical result, no radiological signs of mobilization and non major complication probably related to a shorter and less aggressive operative time and procedure.
