Clin Orthop Surg.  2019 Dec;11(4):436-444. 10.4055/cios.2019.11.4.436.

Conversion of Failed Reverse Total Shoulder Arthroplasty to Hemiarthroplasty: Three Cases of Instability and Three Cases of Glenoid Loosening

• Song IS
• Jung D
• Jeong U
• An CH

• KMID: 2462538
• DOI: http://doi.org/10.4055/cios.2019.11.4.436

Abstract

BACKGROUND
Glenoid loosening and postoperative instability are common causes of failed reverse total shoulder arthroplasty (RTSA). When soft-tissue problems or large glenoid bone defect interferes with reimplantation in revision RTSA, conversion to hemiarthroplasty can be considered. We present a case series of patients who underwent conversion to hemiarthroplasty due to glenoid loosening and early instability after RTSAs, along with clinical results.
METHODS
A total of 72 primary RTSAs using the Aequalis prosthesis were performed at our institution from May 2009 to December 2016. Of these, five patients, including one with humeral neck fracture and absent rotator cuff and four with cuff tear arthropathy, underwent conversion to hemiarthroplasty. Another patient who had RTSA at a local clinic underwent hemiarthroplasty at our institution for unresolved postoperative anterior dislocation. The mean age of the six patients was 71.7 years (range, 62 to 76 years), and the mean follow-up period was 24.4 months (range, 18 to 30 months). Clinical assessments were conducted by using the visual analog scale (VAS), American Shoulder and Elbow Surgery (ASES) score, and University of California at Los Angeles (UCLA) shoulder score at the last follow-up.
RESULTS
The conversion to hemiarthroplasty in the six patients dramatically improved the mean VAS score (preoperative, 8.1; postoperative, 2.5), ASES score (preoperative, 22.1; postoperative, 56.5), and UCLA score (preoperative, 12; postoperative, 18.1). However, the range of motion was almost unchanged after surgery.
CONCLUSIONS
Conversion to hemiarthroplasty can be a good alternative to revision RTSA in patients with serious complications (such as unresolved instability and glenoid loosening) difficult to treat with revision RTSA.

Keyword

Glenoid loosening; Cuff tear arthropathy; Reverse total shoulder arthroplasty; Hemiarthroplasty

MeSH Terms

Arthroplasty*
California
Dislocations
Elbow
Follow-Up Studies
Hemiarthroplasty*
Humans
Neck
Prostheses and Implants
Range of Motion, Articular
Replantation
Rotator Cuff
Shoulder*
Tears
Visual Analog Scale

Figure

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  Fig. 1 Anteroposterior view (A) and outlet view (B) of the shoulder of a 76-year-old female patient, showing anterior dislocation of the humeral prosthesis from the glenoid baseplate.

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  Fig. 2 Anteroposterior view (A), outlet view (B), and axial view (C) of the shoulder obtained after conversion to hemiarthroplasty in a 76-year-old female patient. She had a well-positioned prosthesis but minimal upward migration and acetabularization of the acromion.

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  Fig. 3 Anteroposterior view (A), outlet view (B), and axial view (C) of the shoulder of a 75-year-old female patient, showing upward migration of the two locking screws and two compression screws, suggesting glenoid loosening.

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  Fig. 4 Anteroposterior view (A) and 30° caudal tilt view (B) of the shoulder obtained after conversion to hemiarthroplasty in a 75-year-old female patient with a loosened glenoid baseplate.

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  Fig. 5 Anteroposterior view (A), outlet view (B), and 30° caudal tilt view (C) of the right shoulder of a 62-year-old male patient with unresolved dislocation and severe stiffness after reverse total shoulder arthroplasty. He had axillary neuropathy and a supraspinatus nerve lesion in the right upper extremity.

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  Fig. 6 Anteroposterior view (A), outlet view (B), and axial view (C) of the right shoulder, showing a well-positioned prosthesis after conversion to hemiarthroplasty in a 62-year-old male patient.

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  Fig. 7 Anteroposterior view (A), outlet view (B), and 30° caudal tilt view (C) of the shoulder of a 74-year-old female patient with upward displacement of the glenoid baseplate and hemisphere over the clavicle. The humeral component remained well positioned and well fixed.

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  Fig. 8 Anteroposterior view (A), outlet view (B), and axial view (C) of the shoulder, showing the loosened prosthesis. After conversion to hemiarthroplasty, the glenohumeral joint was well reduced.

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