The Basic Shoulder Arthroplasty: Simple Shoulder Replacement for the Generalist.

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Abstract

[Indexed for MEDLINE] 18. J Shoulder Elbow Surg. 2022 Sep;31(9):1859-1873. doi: 10.1016/j.jse.2022.02.018. Epub 2022 Mar 23. Hemi-reverse revision arthroplasty in the setting of severe glenoid bone loss. Walch A(1), Edwards TB(2), Kilian CM(3), Boileau P(4), Walch G(5), Athwal GS(6). Author information: (1)Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France. Electronic address: arnaud.walch@gmail.com. (2)Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA. (3)Orthopaedic Associates of Wisconsin, Pewaukee, WI, USA. (4)Institut de Chirurgie Réparatrice (ICR), Nice, France. (5)Centre Orthopédique Santy, Lyon, France. (6)Roth|McFarland Hand and Upper Limb Center, Western University, St Joseph's Health Care London, London, ON, Canada. BACKGROUND: Glenoid bone loss is one of the main challenges in revision of failed shoulder arthroplasties. The concept of a hemi-reverse procedure is to implant a glenoid baseplate and glenosphere to protect the glenoid reconstruction to allow it to heal and to preserve the joint space for a potential second-stage humeral component implantation. The purpose of this study was to report the results of hemi-reverse procedures. METHODS: Revision to a hemi-reverse procedure was performed in 15 patients: 8 with a failed anatomic total shoulder arthroplasty, 3 with a failed reverse shoulder arthroplasty, 3 with a failed humeral hemiarthroplasty, and 1 with placement of a cement spacer owing to sepsis after a total shoulder arthroplasty. After complete removal of the initial prosthesis, all patients underwent glenoid reconstruction with bone grafting and implantation of a reverse arthroplasty baseplate and glenosphere. A humeral implant was not placed in any case. The patients were prospectively followed up and underwent complete clinical and radiologic studies preoperatively and postoperatively at a minimum of 2 years after the surgical procedure. RESULTS: Thirteen hemi-reverse implants and glenoid bone grafts healed (86%) and remained radiographically stable. One hemi-reverse construct migrated and became mechanically loose, which was attributed to absent fixation of the central post in the native glenoid bone. In 1 patient, an implant-related infection developed; irrigation and debridement were performed, in addition to revision to a resection arthroplasty. After documented radiographic healing of the hemi-reverse glenoid reconstruction, 5 patients underwent a second-stage revision to a reverse procedure with insertion of a humeral component at a median of 6 months (interquartile range [IQR], 6-8 months). In this group, the median follow-up period was 73 months (IQR, 45-153 months), the median Constant score was 48 (IQR, 41-56), median active forward elevation was 135° (IQR, 100°-150°), and the median Subjective Shoulder Value was 50% (IQR, 50%-60%). In the group of 9 patients with remaining hemi-reverse implants, the median follow-up period was 38 months (IQR, 29-60 months), the median Constant score was 41 (IQR, 38-46), median active forward elevation was 100° (IQR, 80°-100°), and the median Subjective Shoulder Value was 50% (IQR, 40%-60%). CONCLUSION: The hemi-reverse procedure is an effective revision procedure to reconstruct a severely deficient glenoid. The hemi-reverse procedure may function as the definitive procedure, with satisfactory outcomes. Additionally, in patients who undergo the hemi-reverse procedure, second-stage revision to a total reverse procedure can be performed once imaging confirms bone graft and construct stability. Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved. DOI: 10.1016/j.jse.2022.02.018