title: Cement-within-cement technique in revision reverse shoulder arthroplasty.
abstract: BACKGROUND
  The purpose of this study was to determine the complications and results of cement-within cement-humeral fixation in revision reverse shoulder arthroplasty.
  
  
  METHODS
  In 38 shoulders, a cemented humeral component was revised to a cemented reverse humeral component using a cement-within-cement technique. The mean follow-up time was 3.7 (2.0-7.0) years. Clinical, radiologic, and hard outcomes were assessed using the Kaplan-Meier survival method, Fisher exact test, and Student t-test.
  
  
  RESULTS
  The average operative time for the cement-within-cement technique was 153 minutes. There were 7 (18%) nondisplaced intraoperative fractures involving the greater tuberosity that occurred on implant removal; all healed at last follow-up. A second revision surgery was performed in 3 (8%) patients who underwent cement-in-cement humeral component revision for glenoid loosening (n = 1), periprosthetic instability associated with glenoid loosening (n = 1), and periprosthetic humerus fracture (n = 1). The overall implant revision-free survival at 2 and 5 years was 95% and 91%, respectively. Patients experienced significant pain relief, improvements in their shoulder range of motion, and high satisfaction. There was 1 "at-risk" humeral component (grade 4 or higher humeral lucency, moderate subsidence) that did not undergo revision surgery. There were 2 other humeral components with grade 3 humeral lucency, no subsidence.
  
  
  CONCLUSIONS
  Cement-within-cement fixation of the humeral component in revision reverse shoulder arthroplasty is associated with a reasonable operative time, good medium-term survival rates, and good pain relief and functional outcomes with low complications. This technique is an important consideration to preserve humeral bone stock and potentially humeral component and implant stability.
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Houdek
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Hernandez
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Cofield
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sánchez-Sotelo
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: sperling.john@mayo.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Sperling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D001843:Bone Cements; D020878:Device Removal / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology; D006811:Humerus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D057068:Periprosthetic Fractures / Q000209:etiology / Q000601:surgery; D016059:Range of Motion, Articular; D012086:Reoperation / Q000009:adverse effects* / Q000379:methods*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D020069:Shoulder Pain / Q000601:surgery; D000072227:Shoulder Prosthesis / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements
keywords: Cemented; arthroplasty; humeral; reverse: total; revision; shoulder