title: Total shoulder arthroplasty for the treatment of failed hemiarthroplasty in patients with fracture of the proximal humerus.
abstract: BACKGROUND
  Little information is available for the outcomes of conversion to total shoulder arthroplasty (TSA) of failed hemiarthroplasty (HA) implanted for fractures or fracture-dislocations of the proximal humerus.
  
  
  METHODS
  We evaluated the clinical and radiographic results in 16 patients who underwent conversion of HA to TSA due to pain and shoulder disfunction. Patients were a mean age of 63 years at revision, which was occurred a mean of 3.3 years after the HA. The main prerequisites for conversion were forward flexion to at least 60°, no massive cuff tear, or severe resorption or nonunion of the tuberosities. In all cases, a modular prosthesis was used in the HA, uncemented in 14 and cemented in 2. The latest follow-up was a mean of 4.6 years after revision.
  
  
  RESULTS
  The mean Constant score was 50.6 (range, 33-69), with an average increase of 11.9 points compared with the preoperative score (P = .001). In 75% of patients, the mean score was 54.6 (average increase, 15.1 points). The lowest scores occurred in patients with a cemented prosthesis that needed to be removed, and in 1 patient who had loosening of the implanted glenoid that was revised.
  
  
  CONCLUSIONS
  Conversion of HA to TSA can improve the preoperative condition in most patients aged in their 50s or 60s in the absence of rotator cuff deficiency and severe bone loss of the proximal humerus.
authors.affiliation: Italian University of Sport and Movement, Rome, Italy. robby1478@hotmail.com
authors.forename: Roberto
authors.initials: R
authors.lastname: Postacchini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castagna
authors.forename: Mario
authors.initials: M
authors.lastname: Borroni
authors.forename: Gianluca
authors.initials: G
authors.lastname: Cinotti
authors.forename: Franco
authors.initials: F
authors.lastname: Postacchini
authors.forename: Stefano
authors.initials: S
authors.lastname: Gumina
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D062785:Hemiarthroplasty; D006801:Humans; D006811:Humerus / Q000293:injuries / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome