Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty. Surgical technique.
BACKGROUND
While there have been numerous reports concerning glenohumeral arthrodesis for many indications, there is little available information specific to glenohumeral arthrodesis performed after failed prosthetic shoulder arthroplasty. The purpose of this study was to report the outcomes of glenohumeral arthrodesis in the setting of severe glenohumeral bone loss and deltoid muscle and rotator cuff insufficiency following failed prosthetic shoulder arthroplasty.


METHODS
We retrospectively reviewed clinical and radiographic data on seven consecutive patients treated with glenohumeral arthrodesis following a failed prosthetic shoulder arthroplasty between 1997 and 2004. The average duration of clinical follow-up was four years (range, 1.5 to eight years).


RESULTS
Five of the seven patients demonstrated an intact fusion at the time of the latest follow-up. Four of the seven patients had undergone additional bone-grafting procedures in an effort to obtain union. Two of these patients ultimately had a persistent nonunion despite the additional procedures for bone-grafting and revision of the fixation hardware. Overall, the average subjective clinical outcome score (Penn Shoulder Score) improved significantly from 17 points (range, 8 to 33 points) to 58 points (range, 31 to 77 points) (p = 0.008). The most common complication was delayed union requiring additional procedures for bone-grafting and revision of the fixation hardware.


CONCLUSIONS
Treatment of a failed prosthetic shoulder arthroplasty with concomitant extensive glenohumeral bone loss and soft-tissue deficiencies is extremely challenging. The results of this study suggest that glenohumeral arthrodesis can yield satisfactory clinical outcomes. However, both the patient and the surgeon should be aware of the complex nature of this surgery and the frequent need for additional surgical procedures to obtain fusion.
Scalise
Jason J
JJ
The CORE Institute, 3010 West Agua Fria Freeway, Suite 100, Phoenix, AZ 85027, USA. jason.scalise@thecoreinstitute.com
Iannotti
Joseph P
JP
D001174:Arthrodesis / Q000379:methods*; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D016025:Bone Transplantation / Q000379:methods; D020878:Device Removal; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D009984:Orthopedic Fixation Devices; D018579:Patient Selection; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*