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Reversed Revised: What to do when it goes wrong?

B Middernacht, A Van Tongel, L De Wilde

    Acta Orthopaedica Belgica
    |August 18, 2015
    PubMed
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    This summary is machine-generated.

    Revision of reversed total shoulder arthroplasty (RTSA) is challenging. Infection is the primary reason for RTSA revision, with revision to a new reversed prosthesis being the preferred approach.

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    Area of Science:

    • Orthopedic surgery
    • Arthroplasty revision

    Background:

    • Reversed total shoulder arthroplasty (RTSA) offers good outcomes but can fail.
    • Revision of failed RTSA presents significant surgical challenges with many unresolved questions.

    Purpose of the Study:

    • To retrospectively analyze the indications and outcomes of primary RTSA revisions.
    • To evaluate surgical details and clinical results using the Constant Score (CS).

    Main Methods:

    • Retrospective analysis of 37 RTSA revisions between 2004 and 2009.
    • Data collected included indications, surgical procedures, and pre/postoperative Constant Scores.

    Main Results:

    • Infection was the most common indication for revision (23 cases).
    • 25 patients underwent one-stage conversion, 4 had two-stage revisions, and 8 received mega-head prostheses.
    • No significant difference in reinfection rates between one- and two-stage techniques; mega-head prostheses showed lower CS.

    Conclusions:

    • Infection is the leading indication for RTSA revision.
    • Revising to a new reversed prosthesis is recommended, even if multiple procedures are needed.
    • Mega-head prostheses are a viable option when direct RTSA revision is not feasible, yielding reasonable results.