Shawn Sahota1, John W Sperling1, Robert H Cofield2. 1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. 2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: cofield.robert@mayo.edu.
Abstract
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.
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.
Authors: Philipp Moroder; Lukas Ernstbrunner; Christine Zweiger; Maximilian Schatz; Gerd Seitlinger; Robert Skursky; Johannes Becker; Herbert Resch; Rolf Michael Krifter Journal: Int Orthop Date: 2016-07-20 Impact factor: 3.075
Authors: Marc Randall Kristensen Nyring; Bo S Olsen; Müjgan Yilmaz; Michael M Petersen; Gunnar Flivik; Jeppe V Rasmussen Journal: Trials Date: 2020-10-07 Impact factor: 2.279