Symptomatic dysfunction of rotator cuff in anatomic shoulder arthroplasty may require conversion to reverse shoulder arthroplasty (RSA). The case presented in this chapter is a failed hemiarthroplasty (HA) implanted for the treatment of proximal humerus fracture. In this scenario, the relatively high prevalence of complications related to healing of the tuberosities in anatomical position is the main cause of dysfunction of rotator cuff.
The crucial aspects of the revision RSA are dealing with osteopenic bone, determining appropriate length and version of the prosthetic components, and gaining sufficient soft tissue tension in order to provide adequate stability and function of the implant.
In some instances, modular shoulder prosthesis allows implant replacement by removal of the humeral head component without extracting the humeral stem. However, revision surgery is extremely challenging when removal of the entire humeral component is necessary. If longitudinal humeral osteotomy along the bicipital groove does not dislodge the prosthesis, pectoralis major pedicled cortical window osteotomy can be used, as shown in the present case.
This is a preview of subscription content, log in to check access.
Bohsali KI, Wirth MA, Rockwood CA Jr. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88:2279–92.Google Scholar
Chin PY, Sperling JW, Cofield RH, Schleck C. Complications of total shoulder arthroplasty: are they fewer or different? J Shoulder Elb Surg. 2006;15:19–22.CrossRefGoogle Scholar
Young AA, Walch G, Pape G, Gohlke F, Favard L. Secondary rotator cuff dysfunction following total shoulder arthroplasty for primary glenohumeral osteoarthritis: results of a multicenter study with more than five years of follow-up. J Bone Joint Surg Am. 2012;18:685–93.CrossRefGoogle Scholar
Bohsali KI, Bois AJ, Wirth MA. Complications of shoulder arthroplasty. J Bone Joint Surg Am. 2017;99:256–69.CrossRefGoogle Scholar
Hattrup SJ, Cofield RH, Cha SS. Rotator cuff repair after shoulder replacement. J Shoulder Elb Surg. 2006;15:78–83.CrossRefGoogle Scholar
Abdel MP, Hattrup SJ, Sperling JW, Cofield RH, Kreofsky CR, Sanchez-Sotelo J. Revision of an unstable hemiarthroplasty or anatomical total shoulder replacement using a reverse design prosthesis. Bone Joint J. 2013;95-B:668–72.CrossRefGoogle Scholar
Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of proximal humerus. J Shoulder Elb Surg. 2002;11:401–12.CrossRefGoogle Scholar
Kralinger F, Schweiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G, Hübner C, Resch H. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicenter study of 167 patients. J Bone Joint Surg Br. 2004;86:217–9.CrossRefGoogle Scholar
Gronhagen CM, Abbaszadegan H, Revay SA, Adolphson PY. Medium-term results after primary hemiarthroplasty for comminuted proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elb Surg. 2007;16:766–73.CrossRefGoogle Scholar
Kovacic L, Stefanic F, Senekovic V. Clinical and radiological outcome in low profile metaphyseal shoulder fracture prosthesis design. In: 11th European Congress of Trauma and Emergency Surgery. Brussels, Belgium; 2010.Google Scholar
Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007;89:292–300.CrossRefGoogle Scholar
Walker M, Willis MP, Brooks JP, Pupello D, Mulieri PJ, Frankle MA. The use of the reverse shoulder arthroplasty for treatment of failed shoulder arthroplasty. J Shoulder Elb Surg. 2012;21:514–22.CrossRefGoogle Scholar
Patel DN, Young B, Onvekwelu I, Zuckerman JD, Kwon YW. Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elb Surg. 2012;21:1478–83.CrossRefGoogle Scholar
Ortmaier R, Resch H, Matis N, Blocher M, Auffarth A, Mayer M, Hitzl W, Tauber M. Reverse shoulder arthroplasty in revision of failed shoulder arthroplasty – outcome and follow-up. Int Orthop. 2013;37:67–75.CrossRefGoogle Scholar
Randelli P, Randelli F, Compagnoni R, Cabitza P, Ragone V, Pulici L, Banfi G. Revision reverse shoulder arthroplasty in failed shoulder arthroplasties for rotator cuff deficiency. Joints. 2015;3:31–7.CrossRefGoogle Scholar
Gohlke F, Rolf O. Revision of failed fracture hemiarthroplasties to reverse total shoulder prosthesis through the transhumeral approach: method incorporating a pectoralis-major-pedicled bone window. Oper Orthop Traumatol. 2007;19:185–208.CrossRefGoogle Scholar
Kelly JD 2nd, Hobgood ER. Positive culture rate in revision shoulder arthroplasty. Clin Orthop Relat Res. 2009;467:2343–8.CrossRefGoogle Scholar