Published online Jul 18, 2016. doi: 10.5312/wjo.v7.i7.434
Peer-review started: January 14, 2016
First decision: February 29, 2016
Revised: May 4, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: July 18, 2016
AIM: To report the results of fixed-fulcrum fully constrained reverse shoulder arthroplasty for the treatment of recurrent shoulder instability in patients with epilepsy.
METHODS: A retrospective review was conducted at a single facility. Cases were identified using a computerized database and all clinic notes and operative reports were reviewed. All patients with epilepsy and recurrent shoulder instability were included for study. Between July 2003 and August 2011 five shoulders in five consecutive patients with epilepsy underwent fixed-fulcrum fully constrained reverse shoulder arthroplasty for recurrent anterior shoulder instability. The mean duration of epilepsy in the cohort was 21 years (range, 5-51) and all patients suffered from grand mal seizures.
RESULTS: Mean age at the time of surgery was 47 years (range, 32-64). The cohort consisted of four males and one female. Mean follow-up was 4.7 years (range, 4.3-5 years). There were no further episodes of instability, and no further stabilisation or revision procedures were performed. The mean Oxford shoulder instability score improved from 8 preoperatively (range, 5-15) to 30 postoperatively (range, 16-37) (P = 0.015) and the mean subjective shoulder value improved from 20 (range, 0-50) preoperatively to 60 (range, 50-70) postoperatively (P = 0.016). Mean active forward elevation improved from 71° preoperatively (range, 45°-130°) to 100° postoperatively (range, 80°-90°) and mean active external rotation improved from 15° preoperatively (range, 0°-30°) to 40° (20°-70°) postoperatively. No cases of scapular notching or loosening were noted.
CONCLUSION: Fixed-fulcrum fully constrained reverse shoulder arthroplasty should be considered for the treatment of recurrent shoulder instability in patients with epilepsy.
Core tip: Epileptic patients with recurrent shoulder instability pose a significant challenge. We have reported the first series in the literature of patients with epilepsy-related recurrent shoulder instability to be treated with fixed-fulcrum constrained reverse anatomy arthroplasty. Our results suggest that it is successful in reducing pain and eliminating actual and perceived instability in this population. Contrary to previous reports there were no cases of glenoid loosening, implant failure or revision procedures. Postoperatively, there was a significant improvement in functional outcome, which was accompanied by a mean improvement of 25° in active external rotation and 29° in active forward flexion.