title: Reverse total shoulder arthroplasty for the management of failed shoulder arthroplasty with proximal humeral bone loss: is allograft augmentation necessary?
abstract: BACKGROUND
  Patients undergoing revision shoulder arthroplasty frequently have deficient proximal humeral bone stock. Proximal humeral allograft has been recommended to augment reverse total shoulder arthroplasty (RTSA) to improve stability and function. This study reports the results of RTSA without proximal humeral allograft in patients with proximal humeral bone loss secondary to failed shoulder arthroplasty.
  
  
  METHODS
  From 2005 to 2008, 251 patients were enrolled in a prospective RTSA cohort study. Significant humeral bone loss was demonstrated in 15 of 56 undergoing revision for failed arthroplasty. Average age was 67 years. Average bone loss measured 38.4 mm (range, 26-72 mm). Patients were followed up for a minimum of 2 years with American Shoulder and Elbow Surgeons (ASES), Subjective Shoulder Value (SSV), Constant Score (CS), and visual analog scale (VAS) pain scores, as well as self-reported satisfaction and radiographs.
  
  
  RESULTS
  Patients demonstrated significant improvement in mean CS (23.0 to 44.2), ASES (38.2 to 68.3), ASES activities of daily living (7.0 to 15.9), SSV (19.2 to 75.8), and VAS pain (4.6 to 1.6) scores. Thirteen of 15 patients reported satisfaction (87%). Range of motion improved in forward flexion (38.3° to 103.2°) and external rotation (-0.5° to 11.9°). Radiographs demonstrated notching in 3 patients (20%), no humeral subsidence or loosening, and prosthetic fracture of 1 modular humeral stem.
  
  
  CONCLUSIONS
  Use of RTSA for failed shoulder arthroplasty and deficient humeral bone stock provides a significant clinical benefit without the need for allograft augmentation. Monoblock humeral component use may diminish risk for prosthetic fracture.
authors.affiliation: Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI 48073, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Budge
authors.forename: James E
authors.initials: JE
authors.lastname: Moravek
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Zimel
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Nolan
authors.forename: J Michael
authors.initials: JM
authors.lastname: Wiater
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D006801:Humans; D006811:Humerus / Q000637:transplantation*; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D012086:Reoperation; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D017211:Treatment Failure