Clin Orthop Surg.  2015 Sep;7(3):359-364. 10.4055/cios.2015.7.3.359.

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

• Jehan S
• Eltayeb M
• Javaid MM

• KMID: 2234091
• DOI: http://doi.org/10.4055/cios.2015.7.3.359

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.

Keyword

Shoulder; Replacement; Reverse; Polarity; Delta

MeSH Terms

Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement/*adverse effects/*methods
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications/epidemiology
Reoperation/statistics & numerical data
Retrospective Studies
Shoulder Joint/*surgery
Young Adult

Figure

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  Fig. 1 Indications for surgery.

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  Fig. 2 Preoperative and final Constant scores. Pre-op: preoperative.

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  Fig. 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.

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  Fig. 4 Intraoperative photographs showing a broken screw (arrow) on the posterior part of the glenosphere (A) and damaged polyethylene (arrow) (B).

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  Fig. 5 Deltoid detachment with acromion fragment (arrow).

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