Humeral windows and longitudinal splits for component removal in revision shoulder arthroplasty.
BACKGROUND
Removal of a humeral component during revision shoulder arthroplasty can be difficult. If the component cannot be extracted from above, an alternative approach may compromise bone integrity. Two potential solutions are a humeral window and a longitudinal split. This review was performed to determine complications and outcomes associated with these osteotomies during revision arthroplasty.


METHODS
We reviewed records of 427 patients undergoing revision shoulder arthroplasty, identifying those requiring a window or longitudinal split. Outcomes were intraoperative and postoperative complications, rate of healing, and security of implant fixation.


RESULTS
Twenty-six patients underwent creation of a window. Six intraoperative fractures were documented: 5 in greater tuberosity and 1 in humeral shaft. At radiographic follow-up, 23 of 26 windows healed; 2 patients had limited follow-up, and 1 did not have follow-up at our institution. Nineteen patients underwent longitudinal osteotomy. One had intraoperative fracture in greater tuberosity. At radiographic follow-up, 17 of 19 longitudinal splits healed; 1 had limited radiographic follow-up, and 1 did not have follow-up at our institution. Three patients underwent formation of both window and longitudinal osteotomy. At radiographic follow-up, all shoulders healed, and there were no intraoperative or postoperative fractures or malunions.


CONCLUSIONS
In both groups, there were no cases of malunion or clinical loosening. These data suggest that windows and longitudinal splits facilitate controlled removal of well-fixed components with high rate of union and low rate of intraoperative or postoperative sequelae.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Shawn
S
Sahota
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
John W
JW
Sperling
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: cofield.robert@mayo.edu.
Robert H
RH
Cofield
D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D006811:Humerus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery
Revision shoulder arthroplasty; humeral window; longitudinal split