title: The vertical humeral osteotomy for stem removal in revision shoulder arthroplasty: results and technique.
abstract: OBJECTIVE
  Revision shoulder arthroplasty represents a complex and difficult problem for the treating surgeon, with multiple potential complications. In the setting of a well-fixed humeral component, removal can lead to fractures and compromise the outcome of the revision. The current study describes and evaluates the results of a novel vertical humeral osteotomy (VHO) for stem extraction. We hypothesized that the VHO will enable successful stem extraction without perioperative or postoperative fractures.
  
  
  METHODS
  Twenty-seven patients were retrospectively identified who had a VHO for revision shoulder arthroplasty, with 23 patients available for final follow-up. Records and radiographs were reviewed for postoperative complications. Final follow-up was completed with the inclusion of shoulder scores.
  
  
  RESULTS
  There were no perioperative or postoperative fractures on clinical examination and radiographic review at an average follow-up of 41 months. Average American Shoulder and Elbow Surgeons (ASES) score was 64.7 (contralateral ASES, 76.9), average Simple Shoulder Test was 6.3, and the visual analog score pain average was 1.3. There were no instability events.
  
  
  CONCLUSIONS
  The glenoid is the more common site for failure in both hemiarthroplasty and total shoulder arthroplasty. This can lead to a difficult revision procedure if the ingrown or cemented humeral stem requires removal.
  
  
  CONCLUSIONS
  In the current study, we found the VHO was an effective tool for the removal of the humeral prosthesis with no perioperative or postoperative fractures.
authors.affiliation: Department of Orthopaedics, Division of Shoulder and Elbow, Rush University Medical Center, Chicago, IL, USA. gsvanthiel@gmail.com
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Van Thiel
authors.forename: James P
authors.initials: JP
authors.lastname: Halloran
authors.forename: Stacy
authors.initials: S
authors.lastname: Twigg
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Nicholson
mesh_terms: D019643:Arthroplasty, Replacement; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome