Shoulder fusion improves quality of life in patients with contraindications for reverse shoulder arthroplasty

Objectives Shoulder fusion today remains the method of choice in number of severe cases of shoulder surgery when reverse arthroplasty is contraindicated. Such cases include damage to the brachial plexus, axillary nerve palsy in combination with severe atrophy and fatty degeneration of the deltoid muscle 3-4 according to Goutallier, in people with severe physical labor (when the risk of aseptic loosening of the endoprosthesis is very high).

Methods We performed shoulder fusion to 57 patients, average age of the patients was 52.2 years, of which 32 men, 25 women. The leading reason for performing shoulder fusion is the absolute contraindication to reverse shoulder arthroplasty - pronounced dysfunction of the deltoid muscle due to fatty degeneration caused by axillary nerve paralysis resulting from: iatrogenic damage, reverse Hill-Sachs fracture-dislocation, recurring instability of the shoulder joint. For shoulder fusion, we used internal fixator with custom-made plate. Internal fixation was supplemented with bone grafting, including iliac crest graft, coracoid tip flap. The operation was carried out in the “beach chair” patient’s position. We preform 2 surgical approaches - transdeltoid and infraspinatus (2 cm below scapula spine), the shoulder was fixed in 30 degrees of flexion, 30 degrees of abduction, 30 degrees of internal rotation. Long-term results and questionnaires were conducted at least 5 years after the operation.

Results and Conclusion All patients were examined at least 5 years after surgery. Radiographs were performed for all patients to assess a fusion and fixation stability. Functional testing was conducted, surveys on the scales of VAS satisfaction (0 - absolutely not satisfied, 10 - completely satisfied), VAS pain (0 - no pain 10 - severe persistent pain). Constant, ASES, EQ-5D questionnaires were completed by patients to assess function and quality of life in the upcoming study. 18 patients were satisfied with the result within 0-1 VAS points, 32 patients were partially satisfied (3-5 VAS points), 7 patients were not satisfied with the results of the operation (8-10 VAS points). The main reason for dissatisfaction is the limited range of movements. X-ray examination in all cases confirmed formation of bone block and stability of fixation. All interviewed patients noted a decrease level of pain from the initial to operation. Despite the fact that this work evaluates only general data, it can be concluded that shoulder fusion improves the quality of life patients who are contraindicated in reverse shoulder arthroplasty and make it possible to restore the function of upper limb necessary for

self-care.

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Stichwörter shoulder fusion, reverse shoulder arthroplasty, axillary nerve palsy, deltoid muscule disfunction, revision shoulder arthroplasty

Publication History

Article published online:
15 October 2020