Purpose: The purpose of this work was to evaluate the quality of cemented humeral stem fixation. We analysed the incidence and influence of humeral lucent lines and loosening after implantation of a shoulder prosthesis as a function of aetiology (fracture versus scapular osteoarthritis) and glenoid status (total versus partial humeral prosthesis). Material and methods: This retrospective series included 1842 first-intention shoulder prostheses reviewed at mean five years (2–10). We selected patients whose initial diagnosis was fracture of the superior portion of the humerus (n=300) and centred osteoarthritis (n=767). All stems implanted for fracture were cemented. For osteoarthritis, there were 610 total prostheses and 157 simple humeral prostheses: 752 stems were cemented and 15 were implanted without cement. The Constant score and radiographic results (AP and lateral view at least) were noted. Results: For cemented stems, the incidence of radiographic lucent lines and loosening was significantly higher in fractures (40% and 10% respectively) than in centred osteoarthritis (14% and 1%). Lucency and loosening did not influence functional outcome in patients with centred osteoarthritis but had a significantly negative effect on final outcome in fractures. For fractures, the incidence of lucent lines was correlated with migration of the tubercles. For osteoarthritis, there was no difference between total and partial prostheses in terms of loosening, but the functional outcome was significantly better with total prostheses. Conclusion: Fixation of the humeral implant with cement remains the gold standard for shoulder prostheses implanted for centred osteoarthritis. However, cement fixation yields disappointing results for fractures: defective fixation of the humeral stem is correlated with migration of the tubercles. For osteoarthritis, there are not more lucent lines with a total prosthesis which provides the better functional results

Aims. The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. Methods. From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the Oxford Shoulder Score (OSS) at latest follow-up. Kaplan-Meier survivorship analysis was performed with implant revision as the endpoint. Most recently performed radiographs were reviewed for component radiolucent lines (RLLs) and proximal humeral migration. Results. Five shoulders underwent revision surgery (3.5%); three for rotator cuff failure, one for infection, and one for component malposition. Survivorship of the implant was 95.4% (95% confidence interval 90.1% to 97.9%) at five and nine years. Mean OSS improved significantly compared to preoperative values from 19.0 (1 to 35) to 43.3 (7 to 48) (p < 0.001). Radiological analysis was undertaken for 99 shoulders. This revealed humeral RLLs in one case (1%), glenoid RLLs in 15 cases (15.2%), and radiological rotator cuff failure in 22 cases (22.2%). Conclusion. This prospective cohort study shows encouraging short- to mid-term survivorship and clinical and radiological results for the Mathys Affinis Short, Short Stem Total Shoulder Prosthesis. Level of Evidence: IV. Cite this article: Bone Jt Open 2021;2(1):58–65

Aim. Shoulder prosthesis chronic infection is a rare but serious complication, likely to lead to re-interventions and poor functional outcome. Two-stage exchange surgery is considered the standard procedure by most authors. Our hypothesis was that one-stage revision procedure is a valid therapeutic option in the management of chronic infections of shoulder arthroplasty. Method. This was a mono-center retrospective cohort study. All patients who underwent, during the inclusion period, a one-stage revision procedure for a chronic infection of shoulder arthroplasty were included. All patients underwent clinical evaluation (Constant-Murray score), radiological examination (standard X-rays) and a blood test (Complete Blood Count and C-reactive protein), at a minimal one-year follow-up. Primary endpoint of this study was the infectious outcome and secondary endpoints were the functional and radiographic outcomes. Results. 16 shoulder prosthesis in 14 patients (5 females, 9 males) were included. Mean time between primary prosthesis implantation and exchange surgery was 40 months (1–145). Mean follow up was 30,5 months. The principal micro-organism involved was Propionibacterium acnes (9/16) and multiple organisms were found in 6 patients. In 14/16 (87,5%) shoulders, we found no sign of persistent infection at last follow-up. 2/16 (12,5%) shoulders were considered as still infected. On these 2 patients still infected, one refused further revision and the other was not in a good enough medical condition to undergo another procedure. 2 patients required an additional one-stage procedure for a new infection (new pathogen) after a period of two years, both free of infection at last follow-up. At last follow-up, mean Constant score was 54,8 (23–82). 7/14 (50%) patients were satisfied or very satisfied with the global fonctionnal result. Conclusions. One-stage revision procedure seems to be a valid therapeutic option in the management of infected shoulder prosthesis, as it allowed us to eradicate the infection in 87,5% patients in our serie, with a fair clinical result

Aim. A significant number of patients undergoing shoulder arthroplasty surgery have C acnes contamination at the end of the primary surgery. The objective of this study is to determine whether patients with C acnes contamination at the end of their primary shoulder surgery have a worse prognosis than those who end up without C. acnes contamination. Method. Prospective study including all patients who underwent a reverse shoulder prosthesis from January 2015 to December 2018. In all of them, 5 to 12 cultures were performed during primary surgery. The patients underwent surgery for shoulder arthritis secondary to rotator cuff tears, acute fracture of the proximal humerus, and sequelae of fracture of the proximal humerus. Exclusion criteria included the existence of previous surgeries on the affected shoulder, the presence of signs of infection, having received infiltrations and / or complementary invasive examinations (Arthro-MRI and Arthro-CT). Follow-up from 2 to 5 years. Functional assessment according to the Constant Functional Scale. All complications were also recorded. Results. 162 patients were included. Of these, 25 had positive cultures for C. acnes at the end of primary shoulder surgery. Average age of 74.8 years. 136 women and 26 men. 75.9% Shoulder arthritis secondary to rotator cuff tears, 13.6% acute fractures and 10.5% sequelae of fractures. There were no differences between patients with C. acnes and those without C. acnes regarding age and indication for surgery. Predominance of men in the group with positive C. acnes (p <0.001). No differences at 2 and 5 years in the Constant functional scale between the two groups (2 years, 59.6 vs 59.2 p 0.870) (5 years, 62.4 vs 59.5 p 0.360). Significant differences regarding the number of complications (p 0.001). Patients without C. acnes had 1 aseptic loosening of the metaglene and patients with C. acnes had 2 infections, 1 dislocation, and 1 revision surgery. Patients with contamination by C. acnes had more comorbidities (p 0.035) than patients without contamination. Conclusions. Patients with C acnes contamination at the end of primary surgery do not have functional differences when compared with patients without contamination at 2 and 5 years, but they have a higher number of complications in the medium term

Introduction. Modern prostheses of the 3rd and 4th generation facilitate a precise adjustment to various humeral anatomies. This provides major advantages regarding soft tissue balancing and the reconstruction of the rotational center. Thus, high expectations are linked to the use of modern shoulder prostheses compared to conventional designs. Methods. Out of a prospective multicenter study, 108 cases (72 females, 36 males) were reviewed. All patients were treated with the same type of double eccentric shoulder prosthesis. The mean age at surgery was 71.5 years (range, 44.6 to 97.3). The Constant Score (CS), ASES Score, X-rays and complications were evaluated at 3, 6, 12 and 24 months as well as 4, 7 and 10 years follow-up. Results. At a mean follow-up time of 93.3 months, the mean CS improved from preoperative 25.6 (±8.8) to 63.8 (±19.1) points at 7 years. In the same period, the mean ASES Score improved from 24.5 (±12.5) to 79.6 (±19.1). Pain according to the CS was rated preoperatively as high (mean 1.8 points). After 7 years patients suffered from mild to no pain (mean 12.0 points). A total of 7 prostheses were revised, leading to an overall survival rate of 91.5% at 10 years. In 4 cases secondary glenoid erosion was the reason for revision. Conclusion. The clinical results of the investigated prosthesis system are convincing and comparable to other modern shaft prostheses. To achieve an anatomical reconstruction of the rotational center of the humeral head, the use of a double eccentric shoulder prosthesis is recommended

Aims: Outcomes for a RSP to treat either a previous operated shoulder (revision procedure) was compared to a primary RSP. Methods: 20 Primary RSP (6M, 14F) for an irreparable rotator cuff tear (IRCT) with glenohumeral arthritis/anterior superior arch deþciency and 31 revision RSP (10M, 21F) (previous rotator or cuff surgery, hemi or total shoulder arthroplasty) were evaluated at an average of 24 months postoperatively. Mean age at the time of RSP was 72.3 for primaries 67.2 for revisions. Assessment with pre- and postoperatively SF-36, SST, ASES scores, physical exam, satisfaction surveys, and radiographs was performed. Results: Primary RSP improvements/Revision RSP improvements were: 9.4 sf-36 PCS/6.3 sf-36 PCS, 1.8 SST/1.6 SST, 31.8 ASES/17.5 ASES (p< 0.05), 49.2 elevation/14.2 elevation (p< 0.05) and 57.8 external rotation/30 external rotation. 71.3% Excellent/good/. 56% Excellent/good (p< 0.05), 21.4% satisfactory/33.3% satisfactory, 7.1% unsatisfactory outcome/9.5% unsatisfactory outcome. Complications only occurred in the revisions including component disassociation, glenoid loosening, recurrent instability, and infection. Conclusion: Primary RSP provides predictable improvements in pain and function with minimal complications. Revision RSP has a higher complication rate and improvements in pain and function are less reliable. Conventional shoulder arthroplasty for patients with IRCT with glenohumeral arthritis/anterior superior arch deþciency has resulted in adequate pain relief but functional improvement has not been predictable. Thus, the initial operative selection for these patients must consider the effect of a failed reconstructive attempt on patient outcomes

Purpose: Nonunion of the surgical neck of the humerus can occur after orthopaedic or poorly-adapted surgery after displaced subtuberosity or cephalotuberosity fracture. The purpose of this study was to report functional and radiographic outcome after treatment with shoulder prosthesis. Material and methods: Twenty-two patients who had a non-constrained shoulder prosthesis were included in this retrospective multicentric study. Mean age was 70 years and mean follow-up was 45 months (range 2 – 9 years). The initial fracture had two fragments in six patients and was a three-fragment fracture involving the head and the tubercle in thirteen and a four-fragment fracture in three. Orthopaedic treatment was given in ten cases and surgical osteosynthesis was used in twelve. Time from fracture to implant insertion was 20 months. The deltopectoral approach was used for 21 humeral implants and one total shoulder arthroplasty (glenohumeral degeneration). The tuberosities were fixed to the cemented humeral stem and a crown of bone grafts were placed around the nonunion of the surgical neck. All patients were reviewed after a minimum of two years and assessed with the Constant score and x-rays. Results: The absolute Constant score improved from 23 reoperatively to 39 postoperatively with an anterior elevation of 53° to 63°. Pain score (from 3 to 9, p = 0.001) and external rotation (from 13° to 28°, p = 0.01) were significantly improved. Forty-five percent of the patients were satisfied and 55% were dissatisfied. The type of initial treatment, type of initial fracture, and time before implantation of the prosthesis did no affect final outcome. The complication rate was 36% (eight patients), and led to five revision procedures. The radiographic work-up disclosed six cases of persistent nonunion of the greater tuberosity, two proximal migrations of the prosthesis, and one humeral loosening. Conclusion: Outcome of shoulder prosthesis for sequela after fracture of the proximal humerus with nonunion of the surgical neck is poor. No improvement in anterior elevation, force, or motion was achieved. Shoulder prosthesis for sequelae of fracture of the proximal humerus with nonunion of the surgical neck should be considered as a “limited-objective” indication only providing beneficial pain relief

Aims: Displaced proximal humeral fractures are considered a real challenge. Malunion, nonunion, avascular necrosis, arthritis are frequent complications. Thus revision surgery, using reverse shoulder prosthesis, is mandatory both to restore shoulder function and to relieve pain. Our purpose was to understand if clinical outcomes after revision surgery are influenced by the first surgical procedure performed to fix the fracture. Methods: 15 patients, mean age 67±2 yrs, sustained a complex humeral fracture. Group A (8 patients) was treated with reduction and fixation with K-wires, while in Group B (7 patients) a cemented hemiarthroplasty was performed. After primary surgical treatment, both groups required revision surgery and a shoulder reverse prosthesis was implanted. Constant score, Flexion, VAS scale and Dash questionnaire were evaluated preoperatively and at 1 year after revision surgery,. Results: Constant Score improved from 7 to 42 points in Group A, while in Group B from 15 to 41 points (n.s.). Flexion in Group A improved from 30° to 106°, while in Group B from 44° to 94° (n.s.). VAS value decreased from 9 to 2 in Group A and from 8 to 5 in Group B (n.s.). Dash value decreased from 82 to 49 points in Group A and from 75 to 55 points in Group B (n.s.). Conclusions: This study demonstrates that reverse shoulder prosthesis offers a salvage-type solution in revision surgery reguardless the surgical treatmet performed previously. In conclusion reverse shoulder prosthesis is an important tool the surgeon can use in shoulder revision surgery

We report the use of the reverse shoulder prosthesis in the revision of a failed shoulder hemiarthroplasty in 19 shoulders in 18 patients (7 men, 11 women) with severe pain and loss of function. The primary procedure had been undertaken for glenohumeral arthritis associated with severe rotator cuff deficiency. Statistically significant improvements were seen in pain and functional outcome. After a mean follow-up of 44 months (24 to 89), mean forward flexion improved by 26.4° and mean abduction improved by 35°. There were six prosthesis-related complications in six shoulders (32%), five of which had severe bone loss of the glenoid, proximal humerus or both. Three shoulders (16%) had non-prosthesis related complications. The use of the reverse shoulder prosthesis provides improvement in pain and function for patients with failure of a hemiarthroplasty for glenohumeral arthritis and rotator cuff deficiency. However, high rates of complications were associated with glenoid and proximal humeral bone loss

In the question of shoulder arthroplasty, the indications for hemi-arthroplasty or total arthroplasty have been well described. There are advantages and disadvantages to each. This paper reviews 30 cases of use of the Elite® shoulder prosthesis over three years. Results have been good. The procedure calls for few instruments but is effective

Introduction. Insufficient arthroscopic cuff tear reconstruction leading to massive osteoarthritis and irreparable rotator cuff tears might be salvaged by implantation of an inverted total shoulder prosthesis Delta in the elderly. However, despite the generally high success rate and satisfying clinical results of inverted total shoulder arthroplasty, this treatment option has potential complications. Therefore, the objective of this study was a prospective evaluation of the clinical and radiological outcome after a minimum of 2 years follow-up of patients undergoing inverted shoulder replacement with or without prior rotator cuff repair. Patients and Methods. Sixty-eight shoulders in 66 patients (36 women and 30 men) operated between February 2002 and June 2007 with a mean age of 66 years (ranging from 53 to 84 years) were first assessed preoperatively and then at minimum 2 years follow-up, using the Constant score for pain, Constant Shoulder Score, Oxford Shoulder Score, UCLA Shoulder rating scale, DASH Score, Rowe Score for Instability and Oxford Instability Score. 29 patients (Group A) had undergone previous shoulder arthroscopy for cuff tear reconstruction at a mean of 29 months (range 12 to 48 months) before surgery and 39 patients (Group B) underwent primary implantation of an inverted total shoulder prosthesis Delta. Any complications in both groups were assessed according to Goslings and Gouma. Results. We report statistically significant improvements of all obtained scores at a mean follow-up of 42 months (ranging from 24 to 96 months) in both groups. Significant outcome differences between 29 patients with previous shoulder arthroscopy for cuff tear reconstruction and 39 without previous shoulder arthroscopy were not observed. Eight complications occurred altogether, in terms of a nerve lesion once, loosening of the humeral stem three times, and loosening or fracture of the glenoid component four times. Conclusion. We did not detect any statistically significant impact of previous insufficient shoulder arthroscopy for cuff tear reconstruction on the outcome and survival rate after the implantation of the inverted total shoulder prosthesis Delta. We conclude that reverse total shoulder arthroplasty with the Delta prosthesis is significantly beneficial in terms of less shoulder pain, higher stability and gain of range of motion without this beneficial effect being significantly weakened by previous insufficient shoulder arthroscopy for cuff tear reconstruction. We believe that previous arthroscopic cuff tear reconstruction should therefore be included in the treatment algorithm

Rheumatoid arthritis results in pain and loss of function due to gradual destruction of articular cartilage. The shoulder joint is frequently involved and a prosthetic replacement of the humeral head can restore function and relieve pain. Deficiency of the rotator cuff is common in patients with rheumatoid arthritis. Longevity of movement at the intraprosthetic interface of the bipolar shoulder prosthesis is debatable and has not previously been studied in rheumatoid arthritis. We report a radiological study of the intraprosthetic movements of a bipolar shoulder replacement in 25 shoulders in 20 patients with rheumatoid arthritis of mean age 66 years (SD 10 years). Shoulders were X-rayed at a minimum of 3 and a maximum of 10 years from surgery. Measurements were repeated in 12 shoulders 3 years later. The patient was positioned in the scapular plane. An initial X-ray was taken with the arm in neutral and a further X-ray taken with the arm in full active abduction. Measurements were taken to determine the movement at the intraprosthetic interface and at the prosthesis/glenoid interface. Interobserver error and intraobserver error were determined using an intraclass correlation coefficient (ICC). A paired T-test and Pearson Correlation Coefficient were used to compare intraprosthetic movement with prosthesis/glenoid movement. We found that intraprosthetic movement was preserved up to 10 years from surgery. However, there was no significant difference between intraprosthetic movement and shell/glenoid movement, with some shoulders exhibiting paradoxical movement at the intraprosthetic interface. Repeating the measurements after a 3 year interval in a subgroup of 12 shoulders showed a significant difference in intraprosthetic movement. Interobserver and intraobserver reliability for measurements of the movement at the intraprosthetic interface were excellent with a Kappa value of 0.92 for intraobserver error and a Kappa value of 0.94 for interobserver error. We conclude that movement of the bipolar shoulder prosthesis in rheumatoid shoulders at the intraprosthetic interface is preserved up to 10 years from operation but is not related to or significantly different from prosthesis/glenoid movement and requires further investigation

Introduction One of the most difficult aspects of shoulder arthroplasty is retroversion. The ideal angle is about 30 of posterior rotation of humeral head with regard to the frontal plane so that the humeral head squarely faces the glenoid surface in the resting position. The axis, lateral epicondyle- medial epicondyle is often taken as reference and serves as landmark in many arthroplasty instrumentation. [. 1. ,. 2. ]. Clinical experience has shown that estimating a 30 angle in space is definitely not easy even with the help of diverse goniometers. Methods Each operator has to put 3 prostheses with a 30 degrees retroversion according to the position of the forearm so we had proceeded to 52 putting of prostheses . The measures were made by taking into account of the humerus axis, the plan of condyles and angle of inclination of the collar, given by the angle of cutting. Three barycentres of the three humeral sections have determined the humeral axis. The condylar axis is determined from the 2 barycentres of the digitalized points on the anterior articular condylar surfaces. These 2 axis determine the frontal plane on which a reference mark R(x, y, z) is attached with Z lined up with the humeral shaft and X lined up on the condyles. Different angles could then be determined. In the sagittal plan (perpendicular in the humeral axis), the retroversion angles of the prosthesis and the angle of cutting are calculated. Results The standard deviation of the retroversion angle of the prosthesis is 14,22 which is really too high. In fact, 4 prostheses were inserted with poor retroversion (17°, 17°, 18°, 4,4°) and 20 with excessive retroversion (max =65°). This retroversion angle is not dependant on the other factors (cut angle, inclination angle...) The implant height was not taken into account. Conclusions Only 28 of the prostheses were placed in the right orientation within 20° to 40° of retroversion angle. It shows the difficulties to place a shoulder prosthesis in good position.even in standard conditions and with the standard marks

Introduction Shoulder prosthesis of the third generation should allow a better restoration of the center of rotation in the replaced humeral head and a better adaptation to anatomical complex situations. Finally this should lead to an improved functional outcome compared with common types of prosthesis. We performed a retrospective study using the far most accepted scores to assess functional outcome and quality of lifer in order to compare our results with the clinical literature. Materials and Methods 107 patients with a total of 111 prosthesis out of 127 patients were evaluated 3 to 4 years after implantation of a cemented prosthesis of the third generation (Aequalis″< caron> ) combined with a pegged Glenoid. The functional outcome was evaluated with the following scores: DASH, ASES, SPADI and Constant score (CS). Quality of life was rated using short form 36 (SF-36). Further data were recorded using a comorbidity self-assessment, a sociodemographic and a transition questionnaire. Patient data from SF-36, DASH and Constant Score were compared with normative data from age-, sex- and comorbidity corrected control groups. Paired, non-parametric testing was performed with the Wilcoxon-Test and Bonferroni correction. Radiographs were taken in three standard planes and the glenoid was evaluated according to Lazarus et al. Results The Constant score at the time of follow up reached with 72±16 97% of the norm population. The subscore pain improved in average from 3 to 12 (maximum 15) and the subscore mobility from 14 to 32 (maximum 40). Patients with primary arthrosis (n=44) and patients with posttraumatic arthrosis (n=39) had no functional deficits compared to the normal population in contrast to patients with RA (n=17). They showed significantly functional deficits (p< 0.001) in the DASH score as well as in the physical sum scale of the SF-36 (p=0.008). The majority of glenoids showed an incomplete lyses around one dowel (grade I in 70%). Less than 2% showed grade III or IV. Discussion Implantation of a shoulder prosthesis of the third generation leads to good functional results compared with the control population. Functional and physical deficits remain in patients with an underlying RA. Glenoid loosening seems to be of minor concern. Our results prove the good clinical results that are reported in the literature, however they have to be proven with a longer follow-up

Problem: The displacement of the rotation centre of the humeral head in relation to the shaft axis strongly varies individually. In order to measure the position of the pivot points of the head, the Affinis shoulder prosthesis has a double eccentric adjustment possibility that permits to adapt the head to the medial and dorsal offset. So far, such examinations took place exclusively on the anatomical preparation. This raises the question of whether the need for such a prosthetic system can be derived from the anatomical variation of the pivot points. Method: In 126 patients with an Affinis shoulder prosthesis, we calculated the individual rotation centres of the head from the position of the adjustable prosthetic cone and the eccentric position of the head. In addition, we used the Constant Score to record the clinical function. Results: We found great variation of the rotational centres. Therefore we needed the entire setting range of 12mm mediolateral and 6mm dorsoventral. The examination showed that none of the found anatomic head centres could have been reconstructed exactly with a conventional prosthesis. Prosthesis with a single eccentricity would allow correct adjustment in only 22 cases, as the adjustable rotational centres of the head are situated on a circle, which limits the setting possibilities. The Constant Score of the total group improved from 29% preoperatively to 94% after 2 years. Conclusions: The high variation of the head centres indicates the necessity of a freely adjustable system, such as in a double eccentric bearing. This is the only way that permits an optimal reconstruction of the anatomical conditions – it prevents an increased tension of the rotator cuff, reduces the eccentric loading of the glenoid and creates the prerequisites for the anatomical kinematics. The good clinical results speak for the need to observe bony balancing

Introduction Shoulder replacement is a classical indication in 3 and 4 part humeral head fractures, but the results reported in literature are not so good like arthritis. This is for some aspects as healing of tuberosity, rotatory cuff repair and difficult in positioning of prosthesis for lack of landmarks. The aim of this study is to assess the overall outcome of 30 patients treated with shoulder prosthesis for proximal humeral fractures. Methods Quality of life assessment, specific shoulder patients perspective and objective parameters were correlated with position of stem. Height and version of the stem, evaluated with CT scan as reported in Literature, were studied and correlated whether with the other side or with subjective and objective data. Subjective data included SF-36, DASH, Simple shoulder test; active and passive ROM, muscles strength etc. represented objective data. A rigorous statistical analysis was performed. Results No statistical significative correlation were detected between position and subjective outcome. Different data are found for objective data as ROM, that appears correlate with position of stem. Conclusion No papers about these aspects of shoulder replacement exist in Literature. The authors believe that better knowledge of correlation between outcome and technical aspects in shoulder replacement could be important to define surgical practice criteria

A reversed Delta III total shoulder prosthesis was retrieved post-mortem, eight months after implantation. A significant notch was evident at the inferior pole of the scapular neck which extended beyond the inferior fixation screw. This bone loss was associated with a corresponding, erosive defect of the polyethylene cup. Histological examination revealed a chronic foreign-body reaction in the joint capsule. There were, however, no histological signs of loosening of the glenoid base plate and the stability of the prosthetic articulation was only slightly reduced by the eroded rim of the cup

Does the pre-operative range of active anterior elevation alter the outcome of reverse shoulder prosthesis? A review of 96 cases. Aims: The aim of this retrospective study was to analyse the results of reverse shoulder prosthesis in massive, irreparable rotator cuff tears in terms of the preoperative active anterior elevation (AAE). Materials and Methods: This was a retrospective study of 96 reverse shoulder prostheses in patients with a mean age of 74 years, and with an average follow-up of 30 months. We divided the patients into three groups for the purposes of the study. Group 1 had an AAE less than 60° (n=51); group 2 had an AAE between 60 and 120° (n=39); group 3 had an AAE above 120° (n=6). The majority had off-centre arthritis with a Fukuda Hamada classification of IV or V (n=77); only 19 fell within classes I, II or III. We excluded patients who had previously had a failed anterior cuff repair or arthroplasty and those with a diagnosis of rheumatoid arthritis. Results: There was no significant difference in constant score between the three groups based on preoperative AAE: group 1: 63.50; group 2: 65.05; group 3: 65.16. Analysis of the 96 reverse prostheses in relation to the Fukuda Hamada classification also showed no difference: types I, II and III had a constant score of 64.37; types IV and V a score of 63.68. However, the improvement in AAE (I), rotation (RE1 and RI) and in power was significantly greater in shoulders with pseudoparalysis (p< 0.001): group 1: I = 71.43%; group 2: I = 33.48%; group 3: I = 3.03%. The degree of improvement of the pseudoparalytic shoulders (group 1) was influenced by the Fukuda Hamada classification (p< 0.01): 77.78% for stages I, II and III compared with 69% for stages IV and V. Discusssion and conclusion: This retrospective study confirms that the reverse shoulder prosthesis is a beneficial treatment for massive, irreparable cuff tears in older patients with shoulder psuedoparalysis. Its use is debatable if the preoperative AAE is over 120°, in which case hemiarthroplasty may be a better option. The benefit of the reverse prosthesis is greatest in the shoulder with pseudoparalysis, no glenohumeral arthritis (Fukuda I, II or III), and no previous surgical intervention

Purpose of the study: The reversed total shoulder prosthesis is one of the treatments currently proposed for excentered glenoid osteoarthritic degeneration with massive rotator cuff tears. In light of the mediocre or at best highly variable results obtained with osteosynthesis or humeral arthroplasty for four-fragment fractures of the proximal humerus, indications for the reversed total shoulder prosthesis have been widened to include this category of traumatology patients. The purpose of this prospective study was to report outcome with the reversed prosthesis used for complex fracture of the proximal humerus in subjects aged over 70 years. Material and methods: Ten patients, mean age 76 years, underwent surgery performed by the same surgeon to insert a Delta (DePuy) reversed prosthesis for four-fragment complex displaced fracture of the proximal humerus. The deltopectoral approach was used for all patients. The rotator cuff status was assessed intraoperatively. Clinical (Constant score) and radiological assessment were noted at 24 months. Results: During the operation, only three of the ten shoulders presented a full thickness rotator cuff tear. One patients developed a complication requiring revision: early dislocation revised with a retaining polyethylene insert without recurrent dislocation. There were no cases of glenoid loosening at last follow-up. The weighted Constant score was 65/100. A pain-free shoulder was achieved in all ten patients. Anterior elevation was 130° on average, internal rotation reached hand to buttocks and active external rotation 20°. Discussion: In patients aged over 70 years presenting a complex four-fragment fracture of the proximal humerus, the reversed prosthesis enables improved function and restoration of satisfactory joint movement. Early postoperative recovery and the gain in pain relief are encouraging factors. There was however unsatisfactory restoration of active rotation. For the elderly subject, free of a massive rotator cuff tear, rapid recovery after insertion of an reversed prosthesis should be balanced against the possible preservation of active rotations with an anatomic prosthesis

Purpose. Reverse shoulder prosthesis may lead to scapular notching, caused by attrition of the upper humeral component with scapular neck. We compared the clinical and radiographic results obtained with a SMR prosthesis, which allows a concentric or an eccentric glenosphere to be applied. Patients and methods. 67 patients, mean age 73 years, were treated with reverse prosthesis using concentric and eccentric glenosphere. In patients with concentric glenosphere, the glenosphere extended about 4 mm below the glenoid. The eccentric glenosphere protected the upper glenoid neck by its inferior prolongment. Patients were followed for a mean of 33 months. At final F-U the Constant Score (C.S.) and the score with the Simple Shoulder test (S.S.T.) were calculated. Radiographs were obtained to evaluate the presence of scapular notching, psna (prosthesis-scapular neck angle), pgrd (peg- glenoid rim distance) and DBSNG (distance between scapular neck and glenosfere). Included in this study were patients, as much homogeneous as possible by age and pathology, 25 with concentric (Group I) and 30 with eccentric (Group II) glenosphere, who had a minimum F-U of 24 months. Statistical analysis was performed with a paired test. Results. 25 patients of group I and 26 in group II were available for the study. In Group I mean elevation improved from 78° to 122° and mean abduction from 71° to 98°; in Group II from 66° to 148° and 60° to 115°. External and internal rotations were similar in both groups. 14 (56%) patients of Group I, and none of Group II had scapular notching (p<0.001). CS increased from 38 pt to 69 pt in Group I and from 30 pt to 74 pt in Group II. Conclusions. Low implantation of glenosphere did not eliminate scapular notching. Instead, no notching was detected with eccentric glenosphere, which also increased the ROM. The PSNA, DBSNG, PGRD are reliable measures to predict scapular notching