These authors performed a retrospective analysis of 86 primary shoulder replacements (34 hemiarthroplasties, 39 anatomic total shoulder arthroplasties, 13 reverse total shoulder arthroplasties) underwent revision arthroplasty with humeral stem removal between 2004 and 2017. Forty-five patients had cemented primary humeral fixation and 41 had press-fit fixation.
The cemented and cementless cohorts required similar rates of humeral osteotomy (28.9% vs. 29.3%; P = .97) and operative time (133.5 vs.121.3 minutes; P = .16). Cemented vs. press-fit primary stems also had similar rates of humeral lucencies seen on follow-up radiographs after revision (77.1% vs. 60.6%; P = .14).
Overall, there was an 11.6% 90-day complication rate for the entire cohort. There was a 13.3% 90-
day complication rate in the cemented cohort and a 9.8% 90- day complication rate in the cementless cohort, which were not significantly different (P = .61). The 90-day complications after final prosthesis placement included dislocation in 4 patients that was treated with revision and liner exchanges in 3 patients and revision with glenosphere explantation and conversion to hemiarthroplasty in 1 patient; radial nerve palsies in 2 patients that resolved in 1 patient but persisted in 1 patient and ultimately required tendon transfers; infection in 2 patients, both treated with irrigation and débridement with permanent explantation; and persistent pain in 1 patient treated with physical therapy.
Overall, there was an 11.6% 90-day complication rate for the entire cohort. There was a 13.3% 90-
day complication rate in the cemented cohort and a 9.8% 90- day complication rate in the cementless cohort, which were not significantly different (P = .61). The 90-day complications after final prosthesis placement included dislocation in 4 patients that was treated with revision and liner exchanges in 3 patients and revision with glenosphere explantation and conversion to hemiarthroplasty in 1 patient; radial nerve palsies in 2 patients that resolved in 1 patient but persisted in 1 patient and ultimately required tendon transfers; infection in 2 patients, both treated with irrigation and débridement with permanent explantation; and persistent pain in 1 patient treated with physical therapy.
Comment: In the practice of revision surgery, humeral component removal is often needed because of suspected infection, malposition, or need to change to a different implant. As explained in the prior post, these problems are not usually solved by a 'platform' prosthesis.
What is missing in this study is a differentiation among the different types of "press fit" stems. Some have bone ingrowth, some are driven in to a tight diaphysial fit and some have high canal filling ratios - each of which makes the removal difficult and more likely to require a humeral osteotomy.
Our preference is for an impaction-grafted thin stem that provides secure fixation without the risk of fracture on insertion and that provides for straightforward component removal without osteotomy should it become necessary.
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