title: Long-term analysis of revision reverse shoulder arthroplasty using cemented long stems.
abstract: BACKGROUND
  Revision of failed shoulder arthroplasty is often associated with poor results and a high rate of complications. Significant humeral bone loss after removal of long stems poses a considerable surgical challenge. Therefore, the aim of our study was the evaluation of the clinical and radiologic outcome of cemented long-stem humeral components in revision reverse shoulder arthroplasty with a minimum 5 years' follow-up.
  
  
  METHODS
  Between June 2001 and June 2009, revision reverse shoulder arthroplasty using long-stem cemented humeral components was performed in 124 patients. Mean age at time of surgery was 69.6 years (range, 42-87 years). Complete clinical and radiographic data were available in 50 patients at a mean of 7 years (range, 5-11.6 years). Postoperative radiographs were evaluated for radiolucent lines, implant migration, fracture, and glenoid notching.
  
  
  RESULTS
  The mean Constant score improved from 11.1 points (range, 0-27 points) to 39.5 points (range, 14-73 points) at the latest follow-up. Progressive humeral radiolucency was present in 24 patients, including 6 patients demonstrating complete loosening or progressive distal migration of the humeral stem. We noted an overall of 12 additional complications in 8 patients, necessitating revision surgery in 16.
  
  
  CONCLUSIONS
  The use of long-stem humeral components is a beneficial treatment in revision reverse shoulder arthroplasty. Nevertheless, the high percentage of patients with humeral loosening is concerning. Modular cementless revision stems that are adapted to the distal humeral medullary canal and additional distal screw and cable fixation might enhance durable distal fixation in case of advanced bone loss.
authors: Clinic for Shoulder and Elbow Surgery, Bad Neustadt/Saale, Germany. Electronic address: birgitwerner@hotmail.com.
authors: Birgit S
authors: BS
authors: Werner
authors: Clinic for Shoulder and Elbow Surgery, Bad Neustadt/Saale, Germany.
authors: Ayman F
authors: AF
authors: Abdelkawi
authors: Center for Orthopedic Surgery, Würzburg, Germany.
authors: Dorota
authors: D
authors: Boehm
authors: Clinic for Shoulder and Elbow Surgery, Bad Neustadt/Saale, Germany.
authors: Robert
authors: R
authors: Hudek
authors: Department of Orthopedic Surgery, Koenig-Ludwig-Haus, University of Würzburg, Würzburg, Germany.
authors: Piet
authors: P
authors: Plumhoff
authors: Clinic for Shoulder and Elbow Surgery, Bad Neustadt/Saale, Germany.
authors: Klaus J
authors: KJ
authors: Burkhart
authors: Clinic for Shoulder and Elbow Surgery, Bad Neustadt/Saale, Germany.
authors: Frank
authors: F
authors: Gohlke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000295:instrumentation* / Q000379:methods; D001843:Bone Cements; D005260:Female; D005858:Germany; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D000072227:Shoulder Prosthesis; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Revision arthroplasty; bone loss; complication; implant loosening; long-stem humeral component; reverse shoulder arthroplasty