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Reverse Total Shoulder ArthroplastySurvivorship Analysis of Eighty Replacements Followed for Five to Ten Years
Jacques Guery, MD1; Luc Favard, MD1; FrançOis Sirveaux, MD2; Didier Oudet, MD3; Daniel Mole, MD2; Gilles Walch, MD4
1 Service d'Orthopédie et Traumatologie 1, CHU Trousseau, 37044 Tours CEDEX, France. E-mail address for L. Favard: favard@med.univ-tours.fr
2 Clinique de Traumatologie et d'Orthopédie, 49 Rue Hermite, 54000 Nancy, France
3 Clinique Saint Grégoire, 18 Rue Groison, 37100 Tours, France
4 Clinique Sainte Anne Lumière, 85 cours Albert Thomas, 69003 Lyon, France
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (royalties from Tornier Company). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Centre Hospitalier Régional Universitaire de Tours-Université François Rabelais, Tours, France

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Aug 01;88(8):1742-1747. doi: 10.2106/JBJS.E.00851
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Abstract

Background: Reverse total shoulder arthroplasty is currently being used to treat selected patients with disabling shoulder arthropathy. The purposes of this study were to investigate the medium-term results of reverse total shoulder arthroplasty and to analyze the influence of etiology on the result.

Methods: We carried out a multicenter study with a minimum follow-up of five years and determined the survival rate of the prosthesis according to the initial etiology of the shoulder arthropathy. Eighty prostheses were implanted in seventy-seven patients between 1992 and 1998. Sixty-six shoulders had an arthropathy with a massive rotator cuff tear, and fourteen shoulders had a disorder with another etiology (rheumatoid arthritis, trauma, or revision arthropathy). At the time of review, eighteen patients had died and two were lost to follow-up. The remaining fifty-seven patients (sixty shoulders) were examined or interviewed by telephone at a mean follow-up of 69.6 months. Cumulative survival curves were generated with replacement of the prosthesis, glenoid loosening, and a functional Constant score of <30 as the end points.

Results: The survival rate with replacement of the prosthesis and glenoid loosening as the end points were 91% and 84%, respectively, at 120 months, with shoulders that had arthropathy with a massive rotator cuff tear demonstrating a significantly better result than those that had a disorder with another etiology (p < 0.05). On the other hand, the survival rate with an absolute Constant score of <30 as an end point was 58% at 120 months, with no significant difference with respect to etiology. Two breaks were observed in the survival curves. The first concerned survival until replacement of the prosthesis and occurred at around three years, reflecting early loosening of the prosthesis. The curve then became stable. A second break started at around six years and reflected progressive deterioration of the functional result.

Conclusions: Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over seventy years old with low functional demands.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Luc Favard, M.D.
    Posted on November 18, 2006
    A Clarification to "Reverse Shoulder Arthroplasty" by Dr. Favard et al.
    CHU TOURS Service d'Orthopedie et Traumatologie 1 CHU Trousseau 37044 Tours CEDEX, FRANCE

    To The Editor:

    In our article "Reverse Total Shoulder Arthroplasty"(1) we concluded in the Abstract that "Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthopathy with a massive rotator cuff rupture, and it should be used exclusively in patients over seventy years old with low functional demands." However, in the Discussion section we stated, "Also, the functional result is likely to deteriorate progressively after six years, and thus we recommend extreme caution in establishing the indications for this prosthesis, especially in younger patients". Since these two statements are possibly in conflict with each other we wish to clarify this point further.

    While we prefer to use the Reverse Total Shoulder prosthesis in older sedentary individuals when no other good option is available, if a younger patient is willing to accept the risk, and doesn't want the disability associated with a glenohumeral fusion, then the Reverse Total Shoulder Arthroplasty is an acceptable option, but the patient should be carefully advised about not abusing the prosthesis.

    The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (royalties from Tornier Company). Also, a commercial entity (royalties from Tornier Company) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

    Reference:

    1. Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 2006;88:1742-1747.

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