Utility and complications of long-stem humeral components in revision shoulder arthroplasty.
BACKGROUND
Currently, there is little information on the benefits and problems associated with long-stem humeral components in shoulder arthroplasty. This study examined the frequency of use, indications, complications, and security of fixation using a long-stem humeral component in revision shoulder arthroplasty.


METHODS
Eighty revision shoulder arthroplasties were monitored clinically for at least 2 years or until repeat revision surgery. The primary indications for use of an intermediate or long stem were proximal bone loss in 40, nonunion in 14, a malpositioned previous stem with bone loss in 10, an acute intraoperative fracture in 7, an acute preoperative periprosthetic fracture in 5, diaphyseal bone loss in 2, and a box-shaped osteotomy to remove a well-fixed stem in 2. Clinical follow-up was an average of 5.9 years, and radiographic follow-up was an average of 4.7 years.


RESULTS
Intraoperative complications included fracture removing the previous stem in 5, a cortical perforation in 6, and cement extrusion in 7. Late complications included fracture nonunion in 5, deep infection in 2, and component loosening in 1. One component met criteria to be considered radiographically "at risk" for clinical loosening.


CONCLUSIONS
Long-stem humeral components are useful to obtain secure fixation in healthy bone in revision shoulder arthroplasty in patients with proximal bone loss, diaphyseal fracture, or a previously malpositioned stem. Complications are frequent, and caution should be taken to avoid intraoperative fractures, distal cortical perforation, or cement extrusion. These components are at low risk for loosening.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55906, USA.
Christopher J
CJ
Owens
John W
JW
Sperling
Robert H
RH
Cofield
D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome