PMID- 36804025 OWN - NLM STAT- MEDLINE DCOM- 20230522 LR - 20230522 IS - 1532-6500 (Electronic) IS - 1058-2746 (Linking) VI - 32 IP - 6S DP - 2023 Jun TI - Two-year outcomes of the reverse humeral reconstruction prosthesis. PG - S75-S84 LID - S1058-2746(23)00088-5 [pii] LID - 10.1016/j.jse.2023.01.022 [doi] AB - BACKGROUND: Extensive proximal humeral bone loss in the setting of shoulder arthroplasty represents a difficult challenge for the treating surgeon. Achieving adequate fixation with standard humeral prostheses can be problematic. Allograft-prosthetic composites are a viable solution for this problem; however, high rates of complications have been reported. Modular proximal humeral replacement systems are another potential solution, but there is a paucity of outcome data on these implants. This study reports the 2-year minimum follow-up outcomes and complications of a single system reverse proximal humeral reconstruction prosthesis (RHRP) for patients with extensive proximal humeral bone loss. METHODS: We retrospectively reviewed all patients with minimum 2-year follow-up who underwent implantation of an RHRP for either (1) failed shoulder arthroplasty or (2) proximal humerus fracture with severe bone loss (Pharos 2 and 3) and/or sequelae thereof. Forty-four patients met inclusion criteria (average age 68.3 +/- 13.1 years). The average follow-up was 36.2 +/- 12.4 months. Demographic information, operative data, and complications were recorded. Pre- and postoperative range of motion (ROM), pain, and outcome scores were assessed and compared to the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for primary rTSA where available. RESULTS: Of the 44 RHRPs evaluated, 93% (n = 39) had undergone prior surgery and 70% (n = 30) were performed for failed arthroplasty. ROM improved significantly in abduction by 22 degrees (P = .006) and forward elevation by 28 degrees (P = .003). Average pain on a daily basis and pain at worst improved significantly, by 2.0 points (P < .001) and 2.7 points (P < .001), respectively. Mean Simple Shoulder Test score improved by 3.2 (P < .001), Constant score by 10.9 (P = .030), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score by 29.7 (P < .001), University of California, Los Angeles (UCLA), score by 10.6 (P < .001), and Shoulder Pain and Disability Index score by 37.4 (P < .001). A majority of patients achieved the MCID for all outcome measures assessed (56%-81%). The SCB was exceeded by half of patients for forward elevation and the Constant score (50%), and exceeded by the majority of patients for the ASES score (58%) and UCLA score (58%). The complication rate was 28%; the most common complication was dislocation requiring closed reduction. Notably, there were no occurrences of humeral loosening requiring revision surgery. DISCUSSION: These data demonstrate that the RHRP resulted in significant improvements in ROM, pain, and patient-reported outcome measures, without the risk of early humeral component loosening. RHRP represents another potential solution for shoulder arthroplasty surgeons when addressing extensive proximal humerus bone loss. CI - Copyright (c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. FAU - Srinivasan, Ramesh C AU - Srinivasan RC AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Wright, Jonathan O AU - Wright JO AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Hao, Kevin A AU - Hao KA AD - College of Medicine, University of Florida, Gainesville, FL, USA. FAU - King, Joseph J AU - King JJ AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Schoch, Bradley S AU - Schoch BS AD - Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA. FAU - Farmer, Kevin W AU - Farmer KW AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Struk, Aimee M AU - Struk AM AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. FAU - Roche, Christopher P AU - Roche CP AD - Exactech, Inc., Gainesville, FL, USA. FAU - Wright, Thomas W AU - Wright TW AD - Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL, USA. Electronic address: wrightw@ortho.ufl.edu. LA - eng PT - Journal Article DEP - 20230218 PL - United States TA - J Shoulder Elbow Surg JT - Journal of shoulder and elbow surgery JID - 9206499 SB - IM MH - Humans MH - Middle Aged MH - Aged MH - Aged, 80 and over MH - *Shoulder Joint/surgery MH - Treatment Outcome MH - Retrospective Studies MH - *Arthroplasty, Replacement, Shoulder/methods MH - *Arthroplasty, Replacement/methods MH - *Shoulder Prosthesis MH - Pain, Postoperative MH - Prosthesis Design MH - Humerus/surgery MH - Range of Motion, Articular OTO - NOTNLM OT - APC OT - Shoulder arthroplasty OT - endoprosthesis OT - humerus OT - minimal clinically important difference OT - proximal humeral bone loss OT - revision OT - substantial clinical benefit EDAT- 2023/02/22 06:00 MHDA- 2023/05/22 06:42 CRDT- 2023/02/21 18:32 PHST- 2022/08/29 00:00 [received] PHST- 2023/01/12 00:00 [revised] PHST- 2023/01/15 00:00 [accepted] PHST- 2023/05/22 06:42 [medline] PHST- 2023/02/22 06:00 [pubmed] PHST- 2023/02/21 18:32 [entrez] AID - S1058-2746(23)00088-5 [pii] AID - 10.1016/j.jse.2023.01.022 [doi] PST - ppublish SO - J Shoulder Elbow Surg. 2023 Jun;32(6S):S75-S84. doi: 10.1016/j.jse.2023.01.022. Epub 2023 Feb 18.