Hombro / Shoulder / Schulter: El subescapular implicado en la inestabilidad de la PTHi

Instability after reverse total shoulder replacement.

Gallo RA, Gamradt SC, Mattern CJ, Cordasco FA, Craig EV, Dines DM, Warren RF

J Shoulder Elbow Surg 2011 Jun; 20(4):584-90.

Abstract

BACKGROUND

Despite advances in technique and implant design, instability after reverse total shoulder arthroplasty remains a challenging postoperative complication.

MATERIALS AND METHODS

We examined our institutions' first 57 reverse total shoulder arthroplasties performed during a 3-year period (2004-2006). There were 9 cases of instability, all occurring within the first 6 months after surgery.

RESULTS

All 9 patients had compromise of the subscapularis tendon at the time of initial reverse total shoulder implantation. With regard to implant positioning, 2 patients had superiorly inclined metaglenes and 3 had metaglenes positioned superior to the inferior glenoid. Each patient with a dislocation had at least 1 revision surgery, and 4 patients had underlying infection. At most recent follow-up, only 3 patients had a concentrically reduced reverse total shoulder arthroplasty in place whereas 3 remained explanted, 2 chronically dislocated, and 1 chronically subluxated.

CONCLUSIONS

Early instability after reverse total shoulder arthroplasty can be related to inadequate soft tissue, inadequate deltoid tension, malpositioned implants, and/or infection, and outcomes of treatment of early instability are generally poor.