title: Revision total shoulder arthroplasty for painful glenoid arthrosis after humeral head replacement: the posttraumatic shoulder.
abstract: OBJECTIVE
  This study was conducted to test the hypothesis that patients would have improved pain and range of motion after conversion total shoulder arthroscopy but that overall outcome would be substantially affected by the need for removal of the humeral component and associated alterations of bony anatomy or soft tissue deficiencies.
  
  
  METHODS
  Thirty-four patients (34 shoulders) with HHR after a proximal humeral fracture underwent revision total shoulder arthroplasty for painful glenoid arthrosis, with mean follow-up of 9.4 years (range, 2.3-20.4 years). After initial review, repeat analysis was performed based on the complexity of osseous (humeral stem revision) and soft tissue management, including rotator cuff tear, greater tuberosity resorption, malunion or nonunion, or instability.
  
  
  RESULTS
  Overall, patients had reduction in pain (P = .0001), and improved active abduction (P = .05) and external rotation (P = .0005). Less improvement in active abduction was documented in patients who required soft tissue management (P = .03). Results of the modified Neer rating documented 3 excellent, 9 satisfactory, and 22 unsatisfactory results (motion deficiencies in 14). Kaplan-Meier survival analysis free of repeat revision was 100% at 1 year, 96.8% at 5 years (95% confidence interval, 90%-100%), and 92.2% at 10 years (95% confidence interval, 82% to 100%).
  
  
  CONCLUSIONS
  Conversion total shoulder arthroplasty is effective for addressing painful glenoid arthrosis after primary HHR for a proximal humeral fracture, with or without the need to change the humeral component. However, active motion may not improve in patients with rotator cuff tearing, a greater tuberosity nonunion, malunion, or resorption.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rhee
authors.forename: Adam A
authors.initials: AA
authors.lastname: Sassoon
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Schleck
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: John W
authors.initials: JW
authors.lastname: Sperling
authors.forename: Robert H
authors.initials: RH
authors.lastname: Cofield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D019643:Arthroplasty, Replacement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058430:Humeral Head; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome