Management of the Failed Arthroplasty for Proximal Humerus Fracture

Djuro Petkovic, MD; David Kovacevic, MD; William N. Levine, MD; Charles M. Jobin, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(2):39-49. 

In This Article

Outcome of Hemiarthroplasty Revision to Reverse Replacement

Hemiarthroplasty for fracture is a technically demanding procedure that is dependent on rotator cuff function and restoration of tuberosity anatomy and proximal humeral geometry. The results of hemiarthroplasty for fracture are highly dependent on the anatomic healing of the tuberosities compared with those of RTSA.[4] In addition, a host of other common failures exist such as glenoid arthritis, glenoid eccentric wear, deep infection, stiffness, instability, loosening, and component malposition.[1] Multiple randomized control studies have found limited functional benefit to hemiarthroplasty for fracture in elderly patients compared with nonsurgical management.[2,3] The outcome after revision to RTSA was worse for failed hemiarthroplasty for fracture than for failed hemiarthroplasty for arthritis.[31]

The clinical outcome of revision to RTSA for failed hemiarthroplasty for fracture is not frequently described. A study by Patel et al[31] found encouraging results after revision to RTSA. With an average of 3.5 years of follow-up, these failed hemiarthroplasty patients had a mean American Shoulder and Elbow Surgeons score of 64, forward elevation to 112°, and visual analogue scale pain score of 3.7, with a 7% complication rate of periprosthetic fracture. Patients should be educated and expectations should be realistic that results can be disappointing. Dezfuli et al[32] compared primary reverse with revision RTSA after previous hemiarthroplasty for fracture and predictably found worse outcome scores as well as lower scaption strength and external rotation range of motion in the revision group. In the setting of a previous modular stem hemiarthroplasty for fracture that does not require stem extraction, the results are potentially encouraging in terms of low intraoperative complications, decreased surgical time, lower blood loss, fewer subsequent revisions, and improved clinical scores.[33]

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