Reverse Total Shoulder Arthroplasty with a Custom Deltoid Lateralization Sleeve for the Treatment of Failed Arthroplasty and Severe Proximal Humeral Bone Loss.

Abstract

Abstract Introduction Reverse total shoulder arthroplasty (RTSA) is reportedly an effective option in the treatment of glenohumeral arthritis and severe comminuted proximal humeral fractures. To date, RTSA failures and their subsequent revisions are significant issues that have not been well studied. In revision RTSA cases with severe proximal humeral bone loss (PHBL), there is increased risk of early failure [ 4 , 10 , 28 , 30 ]. In this series, the authors evaluate the short-term results of a novel custom-made, patient-specific Deltoid Lateralization Sleeve (DLS) with an adjustable humeral RTSA component for revision of failed arthroplasty with severe bone loss. Methods Patients treated with a custom, adjustable DLS system for revision RTSA between 2012 and 2019 at one institution were identified using medical health records and included in the study. Each patient had undergone multiple previously failed surgeries before the current salvage procedure was performed. Revision RTSAs with less than 5 centimeters (cm) of bone loss, precluding DLS use, were excluded. Data was retrospectively collected and included demographics, surgical history, amount of bone loss in centimeters, preoperative and postoperative range of motion (ROM), patient-reported outcome scores, and postoperative complications. Results From 2012 to 2019, fifteen patients with a mean PHBL of 8.3 cm (range 5-12.5cm) underwent revision RTSA with DLS. Median age was 66.0 years (range 25-81 years). Median clinical and radiographic follow-up was 30 months (range: 23-77 months). Median preoperative active anterior elevation (AE), active external rotation (ER), and active internal rotation (IR) improved from 10° to 120°, 0° to 35°, and 0° to 40°, respectively. Median Visual Analog Scale (VAS) pain score improved from 5 to 0, American Shoulder and Elbow Surgeons (ASES) score improved from 25 to 65, Simple Shoulder Test (SST) score improved from 0 to 46, and Single Assessment Numeric Evaluation (SANE) score improved from 20% to 68%. There were 9 (60%) complications, including 5 major complications requiring revision surgery (33.3%). One patient (6.7%) was lost to follow-up. Discussion/Conclusion Revision RTSA for excessive PHBL with severe tuberosity deficiency can be surgically challenging. Irrespective of the high complication rate, DLS use in patients with severe PHBL and severe tuberosity deficiency may provide favorable long-term glenohumeral reconstruction viability. Level of evidence Level IV