This article is more than 5 years old. Information may no longer be current.
Benefits seen with use of convertible-platform stem for TSA converted to a reverse arthroplasty
Recently published results showed advantages, such as fewer complications, when a convertible-platform humeral stem was used during conversion of a total shoulder arthroplasty to a reverse total shoulder arthroplasty.
Lynn A. Crosby, MD, and colleagues categorized 102 patients who underwent revision of an anatomic shoulder arthroplasty to a reverse total shoulder arthroplasty into patients who needed exchange of the humeral stem (n=73; exchange group) and patients who retained a convertible-platform humeral component (n=29; retention group). Researchers compared patient demographics, operative time, blood management, range of motion, complications and patient-reported outcomes between the two groups.
Results showed patients in the retention group had significantly shorter operative times, as well as significantly less estimated blood loss. However, researchers did not find a significantly smaller percentage of patients who received blood transfusions or significantly less decreases in hemoglobin and hematocrit levels.
At 2 years follow-up, both groups had improvements in ASES and Constant scores, according to results. Although patients in the retention group had a significantly lower prevalence of intraoperative complications, researchers noted no differences in the rate of reoperation between the retention and exchange groups. – by Casey Tingle
Disclosures: Crosby is a consultant for Exactech. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
Back to Top
Since the introduction of reverse shoulder arthroplasty in North America in 2003, shoulder arthroplasty has seen rapid proliferation and expanded use. As a result, revision of these procedures is becoming more common.
This study by Crosby and colleagues reports on the use of a convertible-platform humeral stem in a fairly large group of patients who underwent TSA revision to reverse shoulder arthroplasty, with and without humeral stem retention. They demonstrated that stem retention leads to reduced blood loss, shorter operative time and fewer intraoperative complications. However, in patients with a convertible-platform humeral stem, 78% of stems could be retained. However, 22% of these stems still required exchange, primarily if the stem was loose or malpositioned. Therefore, use of a platform stem can facilitate an easier revision procedure in many, but not all, situations.
As the authors concluded, this stem design can allow retention of a humeral stem if it is well-fixed and well-positioned. This emphasizes the importance of surgeon experience and expertise to the success of any shoulder arthroplasty procedure.