Reverse arthroplasty for patients with chronic locked dislocation of the shoulder (type 2 fracture sequela)

The aim of this multicenter study was to analyze the clinical and radiographic outcome and to report on the types of complications in patients with chronic locked shoulder dislocation treated with reverse shoulder arthroplasty.

Twenty-two patients with a mean age of 71 years were included. The mean duration of follow-up was 3.5 years. Preoperatively, computed tomography or magnetic resonance imaging scans were performed and analyzed for bone defects and the status of the rotator cuff. Radiographs in 2 planes were obtained before arthroplasty and at final follow-up (mean, 3.5 years; range, 2-9 years). The Constant-Murley score was documented, together with active shoulder flexion, external rotation, and internal rotation.

There was a significant increase in mean Constant-Murley score from 13.6 points preoperatively to 47.4 points postoperatively (P < .001). Mean shoulder flexion was 37.7° before arthroplasty and 103° thereafter (P < .001). External rotation increased from -0.5° to 14.7° (P < .003). There were 7 complications (32%), leading to revision surgery in 6 cases (27%). The most common reason for revision surgery was failure of the glenoid component due to bone defects on the glenoid side. Eight patients rated their subjective result as very good, 5 as good, 5 as satisfactory, and 4 as unsatisfactory.

Reverse shoulder arthroplasty may be a viable treatment option for chronic locked shoulder dislocations with concomitant rotator cuff lesions and an intact glenoid. However, improvement in function is only fair and in this series, there was a high percentage of complications requiring re-operation.