Revision total shoulder arthroplasty for painful glenoid arthrosis after humeral head replacement: the posttraumatic shoulder.

Abstract

HYPOTHESIS:

This study was conducted to test the hypothesis that patients would have improved pain and range of motion after conversion total shoulder arthroscopy but that overall outcome would be substantially affected by the need for removal of the humeral component and associated alterations of bony anatomy or soft tissue deficiencies.

MATERIALS AND METHODS:

Thirty-four patients (34 shoulders) with HHR after a proximal humeral fracture underwent revision total shoulder arthroplasty for painful glenoid arthrosis, with mean follow-up of 9.4 years (range, 2.3-20.4 years). After initial review, repeat analysis was performed based on the complexity of osseous (humeral stem revision) and soft tissue management, including rotator cuff tear, greater tuberosity resorption, malunion or nonunion, or instability.

RESULTS:

Overall, patients had reduction in pain (P = .0001), and improved active abduction (P = .05) and external rotation (P = .0005). Less improvement in active abduction was documented in patients who required soft tissue management (P = .03). Results of the modified Neer rating documented 3 excellent, 9 satisfactory, and 22 unsatisfactory results (motion deficiencies in 14). Kaplan-Meier survival analysis free of repeat revision was 100% at 1 year, 96.8% at 5 years (95% confidence interval, 90%-100%), and 92.2% at 10 years (95% confidence interval, 82% to 100%).

DISCUSSION:

Conversion total shoulder arthroplasty is effective for addressing painful glenoid arthrosis after primary HHR for a proximal humeral fracture, with or without the need to change the humeral component. However, active motion may not improve in patients with rotator cuff tearing, a greater tuberosity nonunion, malunion, or resorption.

• Authors: Peter C Rhee, Adam A Sassoon, Cathy D Schleck, William S Harmsen, John W Sperling, Robert H Cofield
• Journal: Journal of shoulder and elbow surgery (J Shoulder Elbow Surg) Vol. 20 Issue 8 Pg. 1255-64 (Dec 2011) ISSN: 1532-6500 [Electronic] United States
• PMID: 21481610 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Arthralgia (diagnosis, etiology, surgery)
• Arthroplasty, Replacement
• Female
• Follow-Up Studies
• Humans
• Humeral Head
• Joint Prosthesis
• Male
• Middle Aged
• Osteoarthritis (complications, physiopathology, surgery)
• Prosthesis Failure
• Range of Motion, Articular
• Reoperation (methods)
• Retrospective Studies
• Shoulder Joint (physiopathology, surgery)
• Treatment Outcome