Failed Reverse Total Shoulder Arthroplasty: What Are Our Bailouts?

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Abstract

Conflict of interest statement: AAOS: Board or committee member American Orthopaedic Society for Sports Medicine: Board or committee member American Shoulder and Elbow Surgeons: Board or committee member Arthrex, Inc: Paid consultant; Research support DePuy, A Johnson & Johnson Company: Research support Linvatec: Research support PLOS One: Editorial or governing board Smith & Nephew: Research support Stryker: Research support. 19. Orthop Traumatol Surg Res. 2014 Oct;100(6 Suppl):S293-8. doi: 10.1016/j.otsr.2014.06.008. Epub 2014 Aug 20. The role of total elbow arthroplasty in traumatology. Mansat P(1), Bonnevialle N(2), Rongières M(2), Bonnevialle P(2); Bone, Joint Trauma Study Group (GETRAUM). Author information: (1)Départementd'orthopédie-traumatologie, hôpital Riquet, centre hospitalier universitaire de Toulouse, place du Dr Baylac, 31059 Toulouse, France. Electronic address: mansat.p@chu-toulouse.fr. (2)Départementd'orthopédie-traumatologie, hôpital Riquet, centre hospitalier universitaire de Toulouse, place du Dr Baylac, 31059 Toulouse, France. Fractures of the distal humerus account for 5% of osteoporotic fractures in subjects older than 60 years. A history of osteoporosis, co-morbidities, and joint comminution make their management difficult. The therapeutic options are limited to functional treatments, osteosynthesis, or either partial or total arthroplasty. Functional treatment of distal humerus fractures in the elderly subject provide inconsistent results, often with persistence of pain with a stiff or unstable elbow. Osteosynthesis remains the reference treatment for these fractures, following the principle of stable and rigid osteosynthesis allowing early mobilization. However, joint comminution and a history of osteoporosis occasionally make it impossible to meet this objective, with a considerable rate of complications and surgical revisions. Total elbow arthroplasty remains an alternative to osteosynthesis with very satisfactory immediate results restoring a painless, stable, and functional elbow. These results seem reproducible and sustainable over time. The complication rate is not uncommon with an approximately 10% surgical revision rate. Elbow hemiarthroplasty remains to be validated in this indication. LEVEL OF EVIDENCE: V. Copyright © 2014 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2014.06.008