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TRANSCRIPT
Reverse shoulder prosthesis:
A salvage option when proximal humeral
fractures treatment fails
G. Porcellini
N. Lollino
F. Campi
F. Pegreffi
P. PaladiniUnit of Shoulder Surgery
Cervesi HospitalCattolica - Italy
Reverse shoulder prosthesis: a salvage option when proximal humeral fractures treatment fails
G. Porcellini, N. Lollino, F. Campi, F. Pegreffi, P. Paladini
My disclosure is in the Final Program Book and in the AAOS database.
I have no potential conflicts with this presentation.
Displaced proximal humeral fractures are a real challenge!
Avascular necrosisNonunionArthritisMalunionImplant failure
Revision surgery mandatory
Releave pain
Restore shoulder function
Are the outcomes of a reverse shoulder prosthesis influenced by previous surgery?
Patients and Methods
• 15 Patients with Complex Humeral fractures– Mean age 67 (+/- 2 years)
• Group A– 8 Patients (ORIF)
• Group B– 7 Patients (Cemented Hemi-arthroplasty)
• More than one year from previous surgery– Evaluated scores:
• Constant Score• Flexion• VAS• Dash
Patients and Methods: Inclusion criteria
• Patients with previous hemiarthroplasty:– a) on X-ray and Ultrasound examination:
• - tuberosity resorption;• - radiolucencies around the stem of the
prosthesis• - glenoid and acromial arthritis• - not-reparable rotator cuff deficiency
– b) on clinical examination• - pain in everyday activities;• - ROM extremely limited (pseudoparalytic
shoulder)
Patients and Methods: Inclusion criteria
• Patients with previous ORIF:– a) on x-ray and on ultrasound exam
• - avascular necrosis• - malunion with malposition of the
tuberosities• - nonunion• - not-reparable rotator cuff deficiency
– b) on clinical examination• - pain in everyday activities;• - ROM extremely limited (pseudoparalytic shoulder)
Results
p> 0,05
Results
p> 0,05
Complications
Radial nerve palsy after hemiarthroplasty revision (1 patient)
Radial nerve surgical exploration
Postoperative haematomas (2 patients)
Results
No statistically differences between patients of group A and group B
1 excellent (14,3%) 5 satisfactory (71,4%) 1 unsatisfactory (14,3%)
group A
group B 3 excellent (37,5%) 2 satisfactory (25%) 3 unsatisfactory (37,5%)
Groups did not significantly differ about surgical time. (p>0,05)
Conclusion
Wall B, Nové-Josserand L, O'Connor DP, Edwards TB, Walch G.:Reverse total shoulder arthroplasty: a review of results according to etiology.J Bone Joint Surg Am. (2007) Jul;89(7):1476-1485
Outcomes of revision surgery with reverse shoulder prosthesis
good but less satisfactory than primary reverse implant
Outcomes independent from first treatment !!!
p > 0,05
Reverse shoulder prosthesis:
A salvage option when proximal humeral fractures
treatment fails
G. Porcellini
N. Lollino
F. Campi
F. Pegreffi
P. PaladiniUnit of Shoulder Surgery
Cervesi HospitalCattolica - Italy
THANKS