Calcaneo-Achilles Allograft Shoulder Interposition Arthroplasty, Novel Technique for Superior Escape Post Hemiarthroplasty for Failed rTSA: A Case Report

Abstract

Reverse total shoulder arthroplasties have become common in orthopaedics to treat osteoarthritis in patients with rotator cuff deficiency. Complications of revision hemiarthroplasty from reverse total shoulder arthroplasty include anterosuperior escape, which is defined as a deficiency of the coracoacromial arch that allows the humeral head to migrate proximally. A 58-year-old woman, with superior escape and massive destruction of the shoulder suspensory complex after hemiarthroplasty conversion from a reverse total shoulder arthroplasty (rTSA), presented to our clinic with chronic, disabling shoulder pain. The patient underwent a novel salvage procedure with a calcaneo-achilles allograft fixed to the remaining glenoid through the proximal humeral shaft. The goal of this procedure was to preserve as much function in the patient’s arm as possible and reduce her chronic shoulder pain. The patient continued to follow up in our clinic for 1 year postoperatively. She noted complete relief of pain by 6 weeks postoperatively. She also denied any neurologic symptoms in her operative extremity. Her patient-reported outcomes indicated major improvement in her preoperative symptoms. A calcaneal-achilles bone tendon allograft interposition arthroplasty may be a viable solution for failed conversion of rTSA to hemiarthroplasty or problems of end-stage arthritis with superior escape and destruction of the shoulder girdle.