Hemiarthroplasty as a salvage treatment for failed reverse total shoulder arthroplasty

Outcomes after revision surgery for glenoid baseplate failure in reverse shoulder arthroplasty

Background

The purpose of this study was to report clinical outcomes in patients who underwent revision surgery for glenoid baseplate failure after index reverse shoulder arthroplasty (RSA).

Methods

A retrospective review was performed to identify patients from 2010 to 2020 at a single institution who sustained glenoid baseplate failure after RSA and underwent revision surgery. Exclusion criteria included periprosthetic joint infection or lack of minimum 1 year clinical and radiographic follow-up. Included patients were contacted for clinical outcomes (American Shoulder Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain, Single Assessment Numeric Evaluation (SANE) and Patient Satisfaction scores).

Results

A total of 24 patients were identified, and 22 out of 24 (92%) patients were available for clinical follow-up at a mean period of 3.4 years after final revision surgery. The mean age was 70 years, and 15 out of 22 (68%) patients were female. A total of 17 patients were revised to RSA, and five patients were revised to hemiarthroplasty. For the 22 included patients, the mean follow-up ASES score was 64.6, VAS pain was 2.4 and SANE was 58%, which were all significantly improved versus pre-revision. In total, 64% of patients were satisfied or completely satisfied.

Discussion

Revision surgery after glenoid baseplate failure in RSA yields unpredictable clinical outcomes. Revision to RSA or hemiarthroplasty both resulted in modest functional results with persistent mild pain.

Periprosthetic shoulder infection management: one-stage should be the way: a systematic review and meta-analysis

BACKGROUND

There is still no consensus among surgeons on whether to perform a 1- or 2-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection, and other clinical complications in order to discuss which is the best strategy for treating periprosthetic joint infection after shoulder arthroplasty.

METHODS

Upon research using the PubMed, Scopus, and Web of Science databases, in November 2022, studies that presented 1- or 2-stage surgical revision as a treatment for periprosthetic joint infection after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) score. Reinfection and complication rates were extracted, and pooled estimates were calculated using the random-effect model.

RESULTS

After careful screening, 44 studies were included, 5 reporting on 1-stage and 30 on 2-stage revisions and 9 assessing both strategies. A total of 185 shoulders were reported in 1-stage revision studies, whereas 526 shoulders were reported in 2-stage revision studies. The overall pooled random-effects reinfection rate was 6.68% (95% confidence interval [CI]: 3.76-10.13), with low heterogeneity (I2 = 28%, P = .03). One-stage revision showed a reinfection rate of 1.14% (95% CI: 0.00-4.88), whereas 2-stage revision analysis revealed a reinfection rate of 8.81% (95% CI: 4.96-13.33). There were significant statistical differences between 1- and 2-stage reinfection rates (P = .04). The overall pooled rate for other clinical complications was 16.76% (95% CI: 9.49-25.15), with high heterogeneity (I2 = 70%, P < .01). One-stage revision had a complication rate of 6.11% (95% CI: 1.58-12.39), whereas the 2-stage revision complication rate was 21.26% (95% CI: 11.51-32.54). This difference was statistically significant (P = .03).

CONCLUSIONS

This is the first systematic review and meta-analysis showing significant statistical differences between 1- and 2-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, 1-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.