title: Revision shoulder arthroplasty: does the stem really matter?
abstract: BACKGROUND
  The management of a failed shoulder arthroplasty represents a complex and difficult problem for the treating surgeon, with potential difficulties and complications that are related to the need to remove a well-fixed stem. The aim of this study is to compare the intraoperative complications, postoperative complications, and outcome of revisions from stemmed arthroplasties (STAs) with those from surface replacement arthroplasties (SRAs).
  
  
  METHODS
  From 2005 to 2012, 40 consecutive revision shoulder arthroplasties were performed at our institute: 17 from STAs and 23 from SRAs. Perioperative events, operation time, blood loss, intraoperative fractures, and use of structural allograft were recorded. Clinical and radiologic outcomes were analyzed.
  
  
  RESULTS
  Operation time, need for humeral osteotomy, need for structural allograft, and number of intraoperative fractures were significantly higher in the STA group. Blood loss, drop in hemoglobin level, need for blood transfusion, and hospitalization time were also higher in the STA group, but these differences were not statistically significant. Reoperation was performed in 3 patients in the SRA group. A significant clinical improvement was observed in both groups. The Constant score was higher in the SRA group.
  
  
  CONCLUSIONS
  Revision of STAs is a more demanding procedure. The postoperative complication rate was slightly higher in the SRA group. The group with revision of SRAs showed slightly better clinical and radiographic results, but there was no statistically significant difference between the groups.
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Luis Gerardo Natera
authors.initials: LG
authors.lastname: Cisneros
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Ehud
authors.initials: E
authors.lastname: Atoun
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Ruben
authors.initials: R
authors.lastname: Abraham
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Oren
authors.initials: O
authors.lastname: Tsvieli
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK.
authors.forename: Juan
authors.initials: J
authors.lastname: Bruguera
authors.affiliation: Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, Berkshire, UK. Electronic address: oferlevy@readingshoulderunit.com.
authors.forename: Ofer
authors.initials: O
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000295:instrumentation*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D016025:Bone Transplantation; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology; D006811:Humerus / Q000601:surgery; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010027:Osteotomy; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery; D000072227:Shoulder Prosthesis / Q000009:adverse effects*
keywords: Revision; arthroplasty; replacement; resurfacing; shoulder; stem