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Case Presentations: Failed and Revision RSA

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Lennard Funk
Lennard Funk

Amit Kapoor. Presented on 23/10/2012

1 of 36
Case presentations Amit Kapoor Upper Limb Fellow
Case 1  72 year old  Retired consultant pathologist  10 month old # proximal humerus  Managed conservatively  Non union
Reverse shoulder replacement aug’12
6/52 check
Revision insert with pec major transfer
Case 2  67 year old female  # dislocation left shoulder feb 2012
ORIF Feb 2012
2/52 f/u
Open stabilisation mar 2012
Redislocation, Re ORIF
Reverse shoulder arthroplasty Oct 2012
Closed reduction
 Open Reduction  Pec Major transfer
 Instability most common complication, 4.7%  Reoperations required in 87%, most commonly exchange of liners
 9/57 cases of instability  Within 6/12 of primary surgery  All needing revision  Only 3 had satisfactory results
 6/44 prosthetic dislocation (13.6%)
Workup  Rule out infection  Non infectious instability Inadequate deltoid tensioning impingement of components insufficiency of subscapularis
Inadequate deltoid tension  Grammont  ‘ Global Decoaptation’ – lack of sufficient deltoid tension forms a space between ball and socket  Tension within conjoint tendon  Surgeons experience  Contralateral limb
Global coaptation increase offset  Increase glenosphere diameter  Neck extension beneath the poly  Increase thickness of poly
Impingement of components  Impingement of implant with scapular neck in adduction To reduce  Component placement flush or extending beyond the inferior glenoid rim  150 downward tilt of component
Subscapularis
 Subscap sparing approch  4 published series  Total of 50 patients  No dislocations
RSA with deltopectoral approach 55 without subscap repair 65 with subscap repair 3 dislocations 2 dislocations
Summary  Multifactorial causation  Increased incidence in #, revision cases  Adequate tensioning of deltoid important  Avoid impingement of components  Subscap repair if possible

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Case Presentations: Failed and Revision RSA

  • 1. Case presentations Amit Kapoor Upper Limb Fellow
  • 2. Case 1  72 year old  Retired consultant pathologist  10 month old # proximal humerus  Managed conservatively  Non union
  • 3.
  • 4.
  • 7. Revision insert with pec major transfer
  • 8. Case 2  67 year old female  # dislocation left shoulder feb 2012
  • 9.
  • 14.
  • 17.
  • 18.
  • 19. Open Reduction  Pec Major transfer
  • 20.
  • 21. Instability most common complication, 4.7%  Reoperations required in 87%, most commonly exchange of liners
  • 22.
  • 23. 9/57 cases of instability  Within 6/12 of primary surgery  All needing revision  Only 3 had satisfactory results
  • 24.
  • 25. 6/44 prosthetic dislocation (13.6%)
  • 26. Workup  Rule out infection  Non infectious instability Inadequate deltoid tensioning impingement of components insufficiency of subscapularis
  • 27. Inadequate deltoid tension  Grammont  ‘ Global Decoaptation’ – lack of sufficient deltoid tension forms a space between ball and socket  Tension within conjoint tendon  Surgeons experience  Contralateral limb
  • 28. Global coaptation increase offset  Increase glenosphere diameter  Neck extension beneath the poly  Increase thickness of poly
  • 29. Impingement of components  Impingement of implant with scapular neck in adduction To reduce  Component placement flush or extending beyond the inferior glenoid rim  150 downward tilt of component
  • 31.
  • 32. Subscap sparing approch  4 published series  Total of 50 patients  No dislocations
  • 33.
  • 34. RSA with deltopectoral approach 55 without subscap repair 65 with subscap repair 3 dislocations 2 dislocations
  • 35.
  • 36. Summary  Multifactorial causation  Increased incidence in #, revision cases  Adequate tensioning of deltoid important  Avoid impingement of components  Subscap repair if possible