Failed shoulder stabilization procedure in the elderly: reverse shoulder replacement is the treatment ultimum

Subramanian Kanthalu Narayanan, Navaladi Muthusamy, Vanaj Kumar Pauldhurai


Shoulder instability, though often seen in younger individuals it can also occur in the elderly. Shoulder instability in the elderly is often missed and definitive management gets delayed. Treatment delay has a significant influence on the choice of surgical procedure and its functional outcome. We report a 77 year old female who presented with a missed anterior dislocation of the glenohumeral joint. She had undergone an open Latarjet procedure for shoulder instability eight months before her presentation. Considering her age, humeral head bone defects, rotator cuff tear and degenerative changes in the joint we opted for a Reverse Shoulder Replacement in her. The patient now has a pain free, stable and mobile shoulder joint. Her pre-operative Constant score was 11 which improved to 67 at 6 months follow up. Now after 12 months follow up, she has active flexion up to 150°, abduction- 90°, external rotation- 10°, internal rotation- 300 and extension- 50°. Reverse shoulder replacement is a viable treatment option for chronic locked shoulder dislocations with concomitant rotator cuff lesions. Though there is a concern about failure of the glenoid component due to bone defects, RSA is still preferable in elderly patients with low functional demand.


Latarjet procedure, Rotator cuff insufficiency, Reverse shoulder replacement, Chronic shoulder dislocation, Failed Latarjet

Full Text:



Jawa A, Riccheti E. In: Court-Brown C, Heckman J, McQueen M, RicciW, Tornetta III P (eds). Rockwood and Green's Fractures in Adults. 8th edition. Philadelphia: Wolters Kluwer Health; 2015: 1503–1566.

Stefko JM, Tibone JE, Cawley PW, ElAttrache NE, McMahon PJ. Strain of the anterior band of the inferior glenohumeral ligament during capsule failure. J Shoulder Elb Surg. 1997;6:473–9.

Yamamoto N, Muraki T, Sperling JW, Steinmann SP, Cofield RH, Itoi E, et al. Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint Surg Am. 2010;92:2059–66.

Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16:677–94.

Moroder P, Schulz E, Mitterer M, Plachel F, Resch H, Lederer S. Long-term outcome after pectoralis major transfer for irreparable anterosuperior rotator cuff tears. J Bone Joint Surg Am. 2017;99:239–45.

Shin SJ, Kim RG, Jeon YS, Kwon TH. Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair. Am J Sports Med. 2017;45(9):1975–81.

Bessiere C, Trojani C, Pelegri C, Carles M, Boileau P. Coracoid bone block versus arthroscopic Bankart repair: a comparative paired study with 5-year follow-up. Orthop Traumatol Surg Res. 2013;99:123–30.

Waterman BR, Chandler PJ, Teague E, Provencher MT, Tokish JM, Pallis MP. Short-term outcomes of glenoid bone block augmentation for complex anterior shoulder instability in a high-risk population. Arthroscopy. 2016;32:1784–90.

Statz JM, Schoch BS, Sanchez-Sotelo J, Sperling JW, Cofield RH. Shoulder arthroplasty for locked anterior shoulder dislocation: a role for the reversed design. Int Orthop. 2017;41:1227–34.

Wiesel BB, Gartsman GM, Press CM, Spencer EE, Morris BJ, Zuckerman JD, et al. What went wrong and what was done about it: pitfalls in the treatment of common shoulder surgery. J Bone Joint Surg Am. 2013;95:2061–70.

Loebenberg MI, Cuomo F. The treatment of chronic anterior and posterior dislocations of the glenohumeral joint and associated articular surface defects. Orthop Clin North Am. 2000;31:23–34.

Cheung E, Willis M, Walker M, Clark R, Frankle MA. Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011;19(7):439–49.

Werner BS, Böhm D, Abdelkawi A, Gohlke F. Glenoid bone grafting in reverse shoulder arthroplasty for long-standing anterior shoulder dislocation. J Shoulder Elbow Surg. 2014;23(11):1655-61.