These authors identified 28 patients who underwent revision of a painful hemiarthroplasty to total shoulder arthroplasty over a 15-year period. Complications were seen in 10 patients and 6 patients required reoperation.
There were 3 intraoperative complications at the time of conversion from failed HA to aTSA, including fracture (humeral shaft in 1 and greater tuberosity in 1) and iatrogenic rotator cuff tear (1). There were 10 postoperative complications, including subscapularis failure (3), infection (1), humeral component loosening (1), hemarthrosis (1), lesser tuberosity nonunion (1), brachial plexus injury (1), glenoid loosening (1), and posterior-superior rotator cuff tear (1). Thus, in total, 13 intraoperative and postoperative complications occurred, giving an overall complication rate of 46%.
Following revision to aTSA, reoperation was required in 6 patients (21.4%). Of these patients, 2 did not require revision of any components (irrigation and débridement in 1 and open subscapularis repair in 1). Reoperations involving component revision included humeral stem revision (2), arthroscopic glenoid excision (1), reverse shoulder arthroplasty (RSA) (1), and cement spacer placement (1).
Of the 3 patients with rotator cuff tears at the time of aTSA, 2 had surviving implants at 84 and 40 months following surgery. The third patient underwent revision to RSA.
Comment: This article demonstrates the complications that can occur - even in experienced hands - when a failed hemiarthroplasty is revised.
We need to learn how to prevent these failures by studying their cause. Interested readers should click on this link: Primary Shoulder Hemiarthroplasty: What Can Be Learned From 359 Cases That Were Surgically Revised?
Some examples and the relative distribution of modes of failure are shown in this figure.
The rate of failure of hemiarthroplasty failure may be minimized by considering the knowledge gained from these failures:
Prevention is obviously preferable to revision.
Fixing the humerus with impaction grafting (as shown above) may facilitate revision of a hemiarthroplasty, should it become necessary.
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Fixing the humerus with impaction grafting (as shown above) may facilitate revision of a hemiarthroplasty, should it become necessary.
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