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Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2019, Number 4

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Ortho-tips 2019; 15 (4)

What do you do when the reverse arthroplasty fails? Management protocols. Scope review

López CRE, Escutia GJG, Gómez AJM

Language: Spanish
References: 29
Page: 222-230
PDF size: 140.83 Kb.


ABSTRACT

Introduction: Reverse arthroplasty is now the shoulder arthroplasty with the most indications and problem-solving capabilities. Of all RSAs (reverse shoulder arthroplasty), more than 50% will have failed within 10 years. The objective of this scope review is to identify the main problems we face when having a patient with a failed reverse prosthesis. Material and methods: A review of the scope of the issue of reverse prosthesis failure and review of reverse shoulder prosthesis was conducted. Due to the recent appearance of this type of problem and its constant change in management, it was decided to make it only from the literature of the last five years December 2014 to November 2019. Results: The main causes of RSA revision are instability (32%), infection (13.8%), dissociation of the glenoid component (12.2%), glenoid loosening (10.4%), humeral loosening (5.5%), difficulty in placing the glenoid base (4.8%), difficulty in placing the gleno-sphere (4.4%). The complete diagnostic approach is vital in order to resolve all complications in a single surgery. Four main factors must be taken into account in this assessment: loosening, bone loss, humeral shortening, glenoid medialization and soft tissue condition. RSA will be attempted in most cases, which is possible 90% of the time, the rest will have to remain with some spacer or interposition arthroplasty. Conclusions: Failed RSA is an entity which requires a careful diagnostic approach and individualized decision making. Treatment of all causes of failure in a single revision surgery is vital for an adequate outcome. To obtain an adequate result, a reverse prosthesis will be attempted in most cases.


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