On (b)(6) 2019: an initial ascend flex reverse surgery was performed on a patient with a dysfunctional 1/3 of the deltoid muscle and was completed without problems.The position of the tray used at this time was aligned with "#6" in the lateral position.(b)(6) 2020: this patient presented for a periodic check up.No images were available, but x-rays did not reveal any abnormalities.(b)(6) 2020: this patient came to the hospital with complaints of pain.The insert appeared to be inverted upside down and it was decided to perform the revision surgery.On (b)(6) 2020: the revision surgery was performed.The insert was found reversed upside down and the tray position was found shifted in "#12" instead of "#6".However, the stem and the tray were firmly interlocked and could not be moved or removed at all, so the stem wasn't removed and the tray was left in the body in the "no.12" position, and only the insert with additional thickness was replaced in the usual orientation.The surgeon commented that he didn't know why only the insert(or only the tray) had rotated without coming off.Since the tray was left in place as it was this time, this patient will need to be monitored for a while to see if the same event occurs again.
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