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Updated: Jan 15, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Heterotopic ossifications in revision reverse shoulder arthroplasty and their impact on long-term outcomes
Raphael Trefzer1, Michel Leisner1, Mustafa Hariri1
1Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.
Background:
Heterotopic ossifications (HO) are frequently observed after joint replacement surgery and may impair joint mobility and clinical outcomes. The incidence and clinical relevance of HO in revision reverse shoulder arthroplasty (RSA) remain unclear. The purpose of this study was to investigate the (1) incidence of HO and (2) the influence of HO on long-term clinical outcomes in a selected patient cohort who underwent revision RSA.
Methods:
We retrospectively identified patients who underwent revision RSA with a minimum follow-up of 5 years. A total of 37 patients (20 female; mean age, 66 years) were examined after a mean follow-up of 10 years. Clinical outcomes included the Constant-Murley Score (CMS) and its age- and sex-adjusted form (aCMS). HO were evaluated on radiographs by two independent raters and graded using a modified Brooker classification. Inter-rater agreement was calculated using Cohen's Kappa. Statistical comparison of means was conducted using student's t-test for normally distributed data. Chi square tests were used to assess the incidence between groups. Spearman's Rho was calculated to investigate correlations between HO grades and clinical outcome.
Results:
HO were observed in 28 of 37 patients (75%). Inter-rater agreement was substantial (Cohen's Kappa = 0.63). The mean aCMS at 10 years was 70.7%; 62% of patients (23/37) reached the patient-acceptable symptomatic state (PASS, defined as aCMS > 61%). HO incidence did not differ between one-stage and two-stage revisions (77% vs. 74%). Higher HO grades were negatively correlated with CMS (r = - 0.412; p = 0.013). Patients with HO grade ≥ 2 had significantly lower aCMS values (61.5% vs. 81.6%; p = 0.03) and were less likely to reach the PASS (40% vs. 88%; p = 0.0003).
Conclusion:
HO show a high incidence in revision RSA and are clinically relevant as they are associated with inferior long-term clinical outcomes in grade 2 or higher. Future studies should emphasize on preventive strategies in patients undergoing revision RSA.
Level Of Evidence Iii:
Therapeutic study.
