title: Management of peri-prosthetic fracture of the humerus with severe bone loss and loosening of the humeral component after total shoulder replacement.
abstract: There is little information about the management   of peri-prosthetic fracture of the humerus after total shoulder replacement   (TSR). This is a retrospective review of 22 patients who underwent   a revision of their original shoulder replacement for peri-prosthetic   fracture of the humerus with bone loss and/or loose components.   There were 20 women and two men with a mean age of 75 years (61   to 90) and a mean follow-up 42 months (12 to 91): 16 of these had   undergone a previous revision TSR. Of the 22 patients, 12 were treated   with a long-stemmed humeral component that bypassed the fracture.   All their fractures united after a mean of 27 weeks (13 to 94).   Eight patients underwent resection of the proximal humerus with   endoprosthetic replacement to the level of the fracture. Two patients   were managed with a clam-shell prosthesis that retained the original   components. The mean Oxford shoulder score (OSS) of the original   TSRs before peri-prosthetic fracture was 33 (14 to 48). The mean   OSS after revision for fracture was 25 (9 to 31). Kaplan-Meier survival   using re-intervention for any reason as the endpoint was 91% (95%   confidence interval (CI) 68 to 98) and 60% (95% CI 30 to 80) at   one and five years, respectively. There were two revisions for dislocation of the humeral head,   one open reduction for modular humeral component dissociation, one   internal fixation for nonunion, one trimming of a prominent screw   and one re-cementation for aseptic loosening complicated by infection,   ultimately requiring excision arthroplasty. Two patients sustained   nerve palsies. Revision TSR after a peri-prosthetic humeral fracture associated   with bone loss and/or loose components is a salvage procedure that   can provide a stable platform for elbow and hand function. Good   rates of union can be achieved using a stem that bypasses the fracture.   There is a high rate of complications and function is not as good as   with the original replacement.
authors.affiliation: The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Sewell
authors.forename: S N
authors.initials: SN
authors.lastname: Kang
authors.forename: N
authors.initials: N
authors.lastname: Al-Hadithy
authors.forename: D S
authors.initials: DS
authors.lastname: Higgs
authors.forename: I
authors.initials: I
authors.lastname: Bayley
authors.forename: M
authors.initials: M
authors.lastname: Falworth
authors.forename: S M
authors.initials: SM
authors.lastname: Lambert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D001862:Bone Resorption / Q000209:etiology; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*