Este artículo es originalmente publicado en:
http://shoulderarthritis.blogspot.mx/2015/05/reverse-total-shoulder-results-and.html?utm_source=twitterfeed&utm_medium=twitter
De:
Frederick A. Matsen III, M.D.
Reverse total shoulder results and complications
The reverse total shoulder offers a treatment option for a problem that previously had none: the unstable, cuff deficient shoulder. There are now substantial reports of the use of this type of prosthesis to manage a wide range of pathologies, including rotator cuff deficiency without arthritis (see example below in which pseudoparalysis after an attempted tuberosity and cuff repair was treated with a reverse total shoulder)
rotator cuff tear arthropathy, rheumatoid arthritis, failed anatomic arthroplasties, arthritis with glenoid bone deficiency, fractures and post traumatic arthritis (as shown in the example below – not that cement was required because the humeral shaft did not allow a secure press fit)
The infection with Propionibacterium in the x-ray on the left was treated with a single stage exchange to a long stem prosthesis. The patient is currently asymptomatic six years after the revision.
The prosthesis was revised to a hemiarthroplasty that was unsatisfactory. Finally a successful revision was accomplished by the removal of posterior scar tissue and revision to a reverse with a 40 mm set of components.
Scapular and acromial fractures can result from excessive deltoid tension producing a fatigue fracture or from bone weakened by screw placement. These fractures are preferably treated non-operatively.
The issues with notching are not so much the ‘notch’ in the scapula but the radiographically unseen damage to the polyethylene of the humeral component
Humeral component failure may result from dissociation of the cup from the stem
Glenoid failure may result from glenosphere-baseplate dissociation,
glenoid fracture,
or failure of fixation
While some cases can be reconstructed, others require salvage conversion to a hemiarthroplasty after glenoid component removal; the clinical results of this conversion are generally poor.
Neurologic lesions can result from dissection, retraction or over lengthening of the arm. Finally, there has been some concern about loss of active external rotation with reverse total designs that medialize the tuberosity, prompting consideration of latissimus dorsi transfers; this problem seems less of an issue with those designs that maintain ‘East-West” tensioning of the residual cuff posteriorly.
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