Tuesday, July 19, 2016

Why all these different approaches to fixation of the humeral component?

The month of July 2016 has featured many different approaches to fixation of the humeral head prosthesis to the humerus that we encountered in the last few weeks of our referral practice of revision surgery. Each of these revisions was technically challenging, but they have one thing in common: all revisions were accomplished using an impaction grafted smooth stem (making one wonder if that method of fixation might have been preferable for the primary procedure). 

The trabeculated stem shown the image below of a dislocated humeral prosthesis required humeral osteotomy for removal before insertion of an impaction grafted reverse shoulder prosthesis.

The resurfacing humeral component required removal in the revision of a failed glenoid component after which an impacting grafted smaller diameter smooth stem prosthesis was used.

 The press fit stem below wedged in the humeral diaphysis before it could be fully seated, resulting in rocking horse loosening of the glenoid component. It was revised with a smaller diameter impaction grafted stem.

 This 'canal preserving' short stem component required removal because of excessive stiffness and concern for infection.

It was revised to a standard stem length prosthesis without any additional bone removal (in fact with the addition of cancellous allograft).

Each of these revised humeral components present their own particular challenges. Our preference remains the impaction grafted stem inserted with minimal endocortical contact because of its virtually universal applicability (as shown in the two ream and run cases we did yesterday, see below) .


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