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Journal of Shoulder and Elbow Surgery

Glenohumeral cerclage for salvage of recalcitrant instability after reverse total shoulder arthroplasty

      Reverse total shoulder arthroplasty (rTSA) reliably reduces pain and improves function in patients with rotator cuff arthropathy, failed shoulder arthroplasty, proximal humeral fractures, and irreparable rotator cuff tears.
      • Boileau P.
      • Watkinson D.
      • Hatzidakis A.M.
      • Hovorka I.
      Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae and revision arthroplasty.
      Nevertheless, postoperative complications are common, and reported rates range between 7% and 21%, with instability being among the most common.
      • Friedman R.J.
      • Flurin P.H.
      • Wright T.W.
      • Zuckerman J.D.
      • Roche C.P.
      Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair.
      • Zumstein M.A.
      • Pinedo M.
      • Old J.
      • Boileau P.
      Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review.
      Instability rates after rTSA have ranged between 0% and 16% with risk factors including male sex, high body mass index, rTSA as revision for a prior failed arthroplasty, failure to adequately tension the soft tissues, and component impingement.
      • Boileau P.
      Complications and revision of reverse total shoulder arthroplasty.
      • Chalmers P.N.
      • Rahman Z.
      • Romeo A.A.
      • Nicholson G.P.
      Early dislocation after reverse total shoulder arthroplasty.
      • Friedman R.J.
      • Flurin P.H.
      • Wright T.W.
      • Zuckerman J.D.
      • Roche C.P.
      Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair.
      • Gallo R.A.
      • Gamradt S.C.
      • Mattern C.J.
      • Cordasco F.A.
      • Craig E.V.
      • Dines D.M.
      • et al.
      Instability after reverse total shoulder replacement.
      • Kohan E.M.
      • Chalmers P.N.
      • Salazar D.
      • Keener J.D.
      • Yamaguchi K.
      • Chamberlain A.M.
      Dislocation following reverse total shoulder arthroplasty.
      Subscapularis insufficiency, or lack of repair, has been evaluated as a risk factor for instability, although clinical studies have been inconclusive regarding the importance of the subscapularis in maintaining rTSA stability.
      • Chalmers P.N.
      • Rahman Z.
      • Romeo A.A.
      • Nicholson G.P.
      Early dislocation after reverse total shoulder arthroplasty.
      • Clark J.C.
      • Ritchie J.
      • Song F.S.
      • Kissenberth M.J.
      • Tolan S.J.
      • Hart N.D.
      • et al.
      Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis.
      • Friedman R.J.
      • Flurin P.H.
      • Wright T.W.
      • Zuckerman J.D.
      • Roche C.P.
      Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair.
      • Vourazeris J.D.
      • Wright T.W.
      • Struk A.M.
      • King J.J.
      • Farmer K.W.
      Primary reverse total shoulder arthroplasty outcomes in patients with subscapularis repair versus tenotomy.

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