Reversed Shoulder Arthroplasty on Chronic Glenohumeral Dislocations: A Small Retrospective Cases Series

Abstract

Introduction: Anterior dislocation of the shoulder may go undiagnosed and may thus left untreated for a variable length of time. Chronic locked anterior dislocations of the glenohumeral joint is a rare condition. Its diagnosis and management can be challenging. Reverse shoulder arthroplasty has yelded satisfactory outcomes in patients with cuff tear arthropaty and other degenerative changes of the shoulder joint. The concept of this implant theoretically allows stabilization of the dislocated shoulder independently of soft tissues defects. Methods: The aim of this study was to evaluate the short term clinical outcomes of patients with the diagnosis of chronic anterior locked glenohumeral dislocation surgically treated with a reverse shoulder arthroplasty. 6 patients were included and treated in our institution with a reversed shoulder arthroplasty for chronic anterior glenohumeral dislocations. They were clinically evaluated at latest followup with the Constant-Murley Score. All patients had preoperative shoulder trauma series X-rays and CT-scan. Results: The average age was 69.5 years and time from dislocation to surgical treatment was 7 weeks. The average time of the latest follow-up and clinical evaluation was 8 months. One of the patient had severe anterior glenoid bone loss and was treated with humeral head autograft. Median Constant-Murley (CM) score at the latest follow-up was 65. Postoperative radiographs at latest follow-up showed no sign of scapular notching, humeral or glenoid loosening or heterotopic ossification. No other complications that required surgical or medical treatment were registered. Conclusion: Some few recent studies have shown promising results for patients who undergo reverse shoulder arthroplasty for chronic anterior dislocation. Besides that, few are the follow-up studies described. With this clinical cases series, it can be concluded that, facing with a rare condition as a chronic anterior locked glenohumeral dislocation, a reversed shoulder replacement can be a reliable method of treatment and good and predictable functional results can be expected. Citation: Frias M, Sousa H, Torres TP, Lourenço P (2018) Reversed Shoulder Arthroplasty on Chronic Glenohumeral Dislocations: A Small Retrospective Cases Series. J Musculoskelet Disord Treat 4:061. doi.org/10.23937/2572-3243.1510061 Accepted: November 22, 2018: Published: November 24, 2018 Copyright: © 2018 Frias M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. ISSN: 2572-3243 DOI: 10.23937/2572-3243.1510061 Frias et al. J Musculoskelet Disord Treat 2018, 4:061 • Page 2 of 4 • was completely released. The glenoid was exposed and then reamed until a “subchondral smile” of cancellous bone was reached. A bone graft harvested from the resected humeral head was performed. If an anterior glenoid defect was present. Once the glenoid plane was smoothly reamed, the central hole of the baseplate is drilled guided by the K-wire, and metal-back is introduced and tapered into the glenoid. The fixation was optimized with one superior and one inferior screws. The glenosphere was assembled (36 mm) to the baseplate and secured with a screw. Reaming of the humeral side was performed and the thickness of the polyethylene determined after a trial reduction. The definitive humeral components were introduced, reduction performed, and the subscapularis reinserted. Finally, a suction drain introduced and the wound was closed.