Use of mismatched components may yield similar outcomes as matched components in RSA
Key takeaways:
- In RSA, mismatched components yielded similar clinical outcomes and re-revision rates vs. matched components.
- Mismatched components were defined as humeral and glenoid components from different manufacturers.
Published results showed use of mismatched reverse shoulder arthroplasty components, defined by humeral and glenoid components from different manufacturers, may yield similar clinical outcomes and re-revision rates as matched components.
“We know that the revision burden in shoulder arthroplasty is looming on the horizon. Many shoulder implant systems are designed to be used with their proprietary configurations, but removing well-fixed components carries an inherent risk of intraoperative complications. Opting to match revision implants to the well-fixed components may force surgeons to implant with a system they are not most comfortable using,” Mark A. Frankle, MD, chief of shoulder service at the Florida Orthopaedic Institute, director of the Florida Orthopaedic Institute/Foundation for Orthopaedic Research and Education Shoulder and Elbow Fellowship Program and clinical professor of orthopedics at the University of South Florida Morsani College of Medicine, told Healio. “Our study found that mismatching components is a viable option that will allow for minimization of risk associated with removing well-fixed components while affording surgeons to utilize components from their preferred system without compromising outcomes. The results of this study may shift the paradigm of always needing to stick with one implant company for all joint replacements.”
Frankle and colleagues performed a retrospective cohort study of data from 492 RSAs performed by a single surgeon between 2012 and 2022. Overall, 44 patients (9%) received mismatched components, which were identified using operative reports and radiographs. After matching for revision indication, 25 patients with mismatched components and 281 patients with matched components were available at 1-year follow-up.
Outcomes included American Shoulder and Elbow Surgeons score, VAS pain core, simple shoulder test (SST) and stability.
At 1 year, mean ASES scores were 62.7 in the mismatched cohort and 60.6 in the matched cohort; mean VAS pain scores were 3.1 in the mismatched cohort and 2.8 in the matched cohort; and mean SST was 4.6 in the mismatched cohort and 5.4 in the matched cohort. In addition, Frankle and colleagues found rates of re-revision were 11% in the mismatched cohort and 13% in the matched cohort. They noted these differences were not significant.
According to the study, stability was scored on a scale of one to 10, with 10 being the most stable. Frankle and colleagues found mean stability scores were significantly increased in the mismatched cohort vs. the matched cohort. At 1 year, mean stability scores were 5.9 in the mismatched cohort and 3.5 in the matched cohort.
Frankle and colleagues noted 11 patients in the mismatched cohort also had components that were mismatched for glenosphere size and socket size. They noted that none of these patients required re-revision.
“While promising, these results are limited by a small sample size and short-term follow-up. A more definitive conclusion about the practice of mismatching implants will require further research with larger data sets and longer follow-up,” Frankle and colleagues wrote in the study.
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