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Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2013)

22.10. - 25.10.2013, Berlin

Conversion of Hemi- or Total- to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Prosthetic Design

Meeting Abstract

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  • presenting/speaker Karl Wieser - Uniklinik Balgrist, Zürich, Switzerland
  • Paul Borbas - Uniklinik Balgrist, Zürich, Switzerland
  • Dominik Meyer - Uniklinik Balgrist, Zürich, Switzerland
  • Christian Gerber - Uniklinik Balgrist, Zürich, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2013). Berlin, 22.-25.10.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocIN21-212

doi: 10.3205/13dkou005, urn:nbn:de:0183-13dkou0056

Published: October 23, 2013

© 2013 Wieser et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: The aim of the study was to evaluate the clinical outcome and the complication and revision rate following conversion of hemi- (HA) or total shoulder arthroplasty (TSA) to reverse total shoulder arthroplasty (RSTA) with or without humeral stem removal.

Methods: Our prospective collected patient data-base was retrospectively reviewed for patients who underwent single stage revision of a HA or TSA to a RSTA between 2005 and 2011.

The Anatomical reverse shoulder arthroplasty system (Zimmer, Winterthur, Switzerland) was used as revision implant in all cases.

Results and conclusion: We identified 56 (28 left, 28 right) shoulders of 54 (38 female, 16 male) patients for further analysis. 48 were converted from a HA and 8 from a TSA to RTSA. Mean age at conversion to RTSA was 67 (range: 44-87) years. The mean time between index surgery and conversion to RTSA was 38 (range: 0-147) months. A conversion to RTSA without stem removal was performed in 13 cases, whereas the stem was exchanged in 43 shoulders. 11 patients had to be excluded from final analysis or were lost to follow up leaving 45 patients (32 with and 13 without stem exchange) with a complete clinical and radiological follow up of at least 12 months postoperatively.

The mean blood loss (485 vs. 831 ml; p=0.001) and surgical time (118 vs. 176 minutes; p=0.0001 was significantly lower in patients without stem exchange.

The group with stem exchange had 13 intraoperative complications and 13 reoperations, whereas one intraoperative complication and 3 reoperations were detected in the 13 patients without stem removal.

The mean improvements of the pre- to the postoperative relative and absolute Constant scores were 28 (range: -15-100) % and 21 (range: -11-64) points and the difference in SSV was 27 (range: -25-80) points in the study group (p<0.0001). There was, however, no significant differences (relative CS: p=0.34; total CS: p=0.48; SSV: p=0.66) between the groups with or without stem removal.

We were able to demonstrate that the surgical time, intraoperative blood loss, intraoperative complications and rate of revision surgery, can be markedly reduced with the use of modular shoulder arthroplasty system where the stem could be left in place and converted to a RTSA. Despite a higher drop out rate due to revision surgery, we were unable to detect a significant difference in patients satisfaction or clinical outcome between the two groups if the implant had not be re-revised during the follow up period.