Long stem reverse total shoulder to the rescue

A middle aged patient sustained a proximal humeral fracture that was treated elsewhere with a humeral prosthesis as shown below. Note the absence of the greater tuberosity in this reconstruction indicating cuff deficiency.

As a result of this cuff deficiency the humeral head migrated superiorly and the patient developed pseudo paralysis.

A reverse total shoulder was placed, but there was difficulty in clearing the distal cement, so a short stem prosthesis was placed.

The humeral stem loosened.

We revised this arthroplasty using a 6mm diameter long stem prosthesis inserted after drilling the canal with a flexible reamer placed over a bulb-tipped guide wire. The fixation was excellent. Note the slight 'flex' in the prosthetic stem. 

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Long stem humeral components in arthroplasty revision

Utility and complications of long-stem humeral components in revision shoulder arthroplasty

These authors report the minimum two year followup on 80 revision shoulder arthroplasties. Intermediate or long stem were used for proximal bone loss in 40, nonunion in 14, a malpositioned previous stem with bone loss in 10, an acute intraoperative fracture in 7, an acute preoperative periprosthetic fracture in 5, diaphyseal bone loss in 2, and a box-shaped osteotomy to remove a well-fixed stem in 2. Clinical follow-up was an average of 5.9 years, and radiographic follow-up was an average of 4.7 years.

Intraoperative complications included fracture removing the previous stem in 5, a cortical perforation in 6, and cement extrusion in 7. Late complications included fracture nonunion in 5, deep infection in 2, and component loosening in 1.

Our approach to humeral component revision can be seen here.

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Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.


See from which cities our patients come.


See the countries from which our readers come on this post.