Original Research

Humeral Bone Loss in Revision Shoulder Arthroplasty

Publish date: February 15, 2018

TAKE-HOME POINTS

Different preoperative diagnoses lead to distinct patterns of bone loss in revision shoulder arthroplasty.
A variety of techniques should be utilized to address the specific pathologies encountered.
Advanced proximal humeral bone loss results in limited substrate available for humeral component fixation.
Monoblock humeral stems can be used without allografts in cases with mild humeral bone loss.
The revision of loose humeral stems dictates the use of large diaphyseal allografts in the majority of cases.

References

1. Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg. 2010;19(8):1115-1120. doi:10.1016/j.jse.2010.02.009.

2. Padegimas EM, Maltenfort M, Lazarus MD, Ramsey ML, Williams GR, Namdari S. Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res. 2015;473(6):1860-1867. doi:10.1007/s11999-015-4231-z.

3. Walker M, Willis MP, Brooks JP, Pupello D, Mulieri PJ, Frankle MA. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21(4):514-522. doi:10.1016/j.jse.2011.03.006.

4. Levy JC, Virani N, Pupello D, et al. Use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty in patients with glenohumeral arthritis and rotator cuff deficiency. J Bone Joint Surg Br. 2007;89(2):189-195. doi:10.1302/0301-620X.89B2.

5. Melis B, Bonnevialle N, Neyton L, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elbow Surg. 2012;21(3):342-349. doi:10.1016/j.jse.2011.05.021.

6. Deutsch A, Abboud JA, Kelly J, et al. Clinical results of revision shoulder arthroplasty for glenoid component loosening. J Shoulder Elbow Surg. 2007;16(6):706-716. doi:10.1016/j.jse.2007.01.007.

7. Kelly JD, Zhao JX, Hobgood ER, Norris TR. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012;21(11):1516-1525. doi:10.1016/j.jse.2011.11.021.

8. Black EM, Roberts SM, Siegel E, Yannopoulos P, Higgins LD, Warner JJP. Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger. J Shoulder Elbow Surg. 2014;23(7):1036-1042. doi:10.1016/j.jse.2014.02.019.

9. Composite P, Chacon BA, Virani N, et al. Revision arthroplasty with use of a reverse shoulder. J Bone Joint Surg. 2009;1:119-127. doi:10.2106/JBJS.H.00094.

10. Klein SM, Dunning P, Mulieri P, Pupello D, Downes K, Frankle MA. Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse shoulder arthroplasty. J Bone Joint Surg Am. 2010;92(5):1144-1154. doi:10.2106/JBJS.I.00778.

11. Patel DN, Young B, Onyekwelu I, Zuckerman JD, Kwon YW. Reverse total shoulder arthroplasty for failed shoulder arthroplasty. J Shoulder Elbow Surg. 2012;21(11):1478-1483. doi:10.1016/j.jse.2011.11.004.

12. Cuff D, Levy JC, Gutiérrez S, Frankle MA. Torsional stability of modular and non-modular reverse shoulder humeral components in a proximal humeral bone loss model. J Shoulder Elbow Surg. 2011;20(4):646-651. doi:10.1016/j.jse.2010.10.026.

13. Morgan SJ, Furry K, Parekh A, Agudelo JF, Smith WR. The deltoid muscle: an anatomic description of the deltoid insertion to the proximal humerus. J Orthop Trauma. 2006;20(1):19-21. doi:10.1097/01.bot.0000187063.43267.18.

14. Gagey O, Hue E. Mechanics of the deltoid muscle. A new approach. Clin Orthop Relat Res. 2000;375:250-257. doi:10.1097/00003086-200006000-00030.

15. De Wilde L, Plasschaert F. Prosthetic treatment and functional recovery of the shoulder after tumor resection 10 years ago: a case report. J Shoulder Elbow Surg. 2005;14(6):645-649. doi:10.1016/j.jse.2004.11.001.

16. Wataru S, Kazuomi S, Yoshikazu N, Hiroaki I, Takaharu Y, Hideki Y. Three-dimensional morphological analysis of humeral heads: a study in cadavers. Acta Orthop. 2005;76(3):392-396. doi:10.1080/00016470510030878.

17. Tillett E, Smith M, Fulcher M, Shanklin J. Anatomic determination of humeral head retroversion: the relationship of the central axis of the humeral head to the bicipital groove. J Shoulder Elbow Surg. 1993;2(5):255-256. doi:10.1016/S1058-2746(09)80085-2.

18. Doyle AJ, Burks RT. Comparison of humeral head retroversion with the humeral axis/biceps groove relationship: a study in live subjects and cadavers. J Shoulder Elbow Surg. 1998;7(5):453-457. doi:10.1016/S1058-2746(98)90193-8.

19. Johnson JW, Thostenson JD, Suva LJ, Hasan SA. Relationship of bicipital groove rotation with humeral head retroversion: a three-dimensional computed tomographic analysis. J Bone Joint Surg Am. 2013;95(8):719-724. doi:10.2106/JBJS.J.00085.

20. Hromádka R, Kuběna AA, Pokorný D, Popelka S, Jahoda D, Sosna A. Lesser tuberosity is more reliable than bicipital groove when determining orientation of humeral head in primary shoulder arthroplasty. Surg Radiol Anat. 2010;32(1):31-37. doi:10.1007/s00276-009-0543-6.

21. Hertel R, Knothe U, Ballmer FT. Geometry of the proximal humerus and implications for prosthetic design. J Shoulder Elbow Surg. 2002;11(4):331-338. doi:10.1067/mse.2002.124429.

22. Pearl ML. Proximal humeral anatomy in shoulder arthroplasty: Implications for prosthetic design and surgical technique. J Shoulder Elbow Surg. 2005;14(suppl 1):99-104. doi:10.1016/j.jse.2004.09.025.

23. Robertson DD, Yuan J, Bigliani LU, Flatow EL, Yamaguchi K. Three-dimensional analysis of the proximal part of the humerus: relevance to arthroplasty. J Bone Joint Surg Am. 2000;82-A(11):1594-1602.

24. Mochizuki T, Sugaya H, Uomizu M, et al. Humeral insertion of the supraspinatus and infraspinatus. J Bone Joint Surg Am. 2008;90(5):962-969. doi:10.2106/JBJS.G.00427.

25. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy. 2008;24(9):997-1004. doi:10.1016/j.arthro.2008.04.076.

26. Nimura A, Kato A, Yamaguchi K, et al. The superior capsule of the shoulder joint complements the insertion of the rotator cuff. J Shoulder Elbow Surg. 2012;21(7):867-872. doi:10.1016/j.jse.2011.04.034.

27. Rispoli DM, Athwal GS, Sperling JW, Cofield RH. The anatomy of the deltoid insertion. J Shoulder Elbow Surg. 2009;18(3):386-390. doi:10.1016/j.jse.2008.10.012.

28. Schwartz DG, Kang SH, Lynch TS, et al. The anterior deltoid’s importance in reverse shoulder arthroplasty: a cadaveric biomechanical study. J Shoulder Elbow Surg. 2013;22(3):357-364. doi:10.1016/j.jse.2012.02.002.

29. Walker M, Brooks J, Willis M, Frankle M. How reverse shoulder arthroplasty works. Clinical Orthop Relat Res. 2011;469(9):2440-2451. doi:10.1007/s11999-011-1892-0.

30. Torrens C, Corrales M, Melendo E, Solano A, Rodríguez-Baeza A, Cáceres E. The pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiarthroplasty for fracture. J Shoulder Elbow Surg. 2008;17(6):947-950. doi:10.1016/j.jse.2008.05.041.

31. Ponce BA, Thompson KJ, Rosenzweig SD, et al. Re-evaluation of pectoralis major height as an anatomic reference for humeral height in fracture hemiarthroplasty. J Shoulder Elbow Surg. 2013;22(11):1567-1572. doi:10.1016/j.jse.2013.01.039.

32. LaFrance R, Madsen W, Yaseen Z, Giordano B, Maloney M, Voloshin I. Relevant anatomic landmarks and measurements for biceps tenodesis. Am J Sports Med. 2013;41(6):1395-1399. doi:10.1177/0363546513482297.

33. Beck PA, Hoffer MM. Latissimus dorsi and teres major tendons: separate or conjoint tendons? J Pediatr Orthop. 1989;9(3):308-309.

34. Bhatt CR, Prajapati B, Patil DS, Patel VD, Singh BGP, Mehta CD. Variation in the insertion of the latissimus dorsi & its clinical importance. J Orthop. 2013;10(1):25-28. doi:10.1016/j.jor.2013.01.002.

35. Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg. 2006;88(1):113-120. doi:10.2106/JBJS.E.00282.

36. Elhassan B, Christensen TJ, Wagner ER. Feasibility of latissimus and teres major transfer to reconstruct irreparable subscapularis tendon tear: an anatomic study. J Shoulder Elbow Surg. 2014;23(4):492-499. doi:10.1016/j.jse.2013.07.046.

37. Pouliart N, Gagey O. Significance of the latissimus dorsi for shoulder instability. II. Its influence on dislocation behavior in a sequential cutting protocol of the glenohumeral capsule. Clin Anat. 2005;18(7):500-509. doi:10.1002/ca.20181.

38. Budge MD, Moravek JE, Zimel MN, Nolan EM, Wiater JM. Reverse total shoulder arthroplasty for the management of failed shoulder arthroplasty with proximal humeral bone loss: is allograft augmentation necessary? J Shoulder Elbow Surg. 2013;22(6):739-744. doi:10.1016/j.jse.2012.08.008.

39. Weiser MC, Lavernia CJ. Trunnionosis in total hip arthroplasty. J Bone Joint Surg Am. 2017;99(17):27-29. doi:10.2106/JBJS.17.00345.

40. Cohen J. Current concepts review. Corrosion of metal orthopaedic implants. J Bone Joint Surg Am. 1998;80(10):1554.

41. Meijer ST, Paulino Pereira NR, Nota SPFT, Ferrone ML, Schwab JH, Lozano Calderón SA. Factors associated with infection after reconstructive shoulder surgery for proximal humerus tumors. J Shoulder Elbow Surg. 2017;26(6):931-938. doi:10.1016/j.jse.2016.10.014.

42. Wagner ER, Houdek MT, Hernandez NM, Cofield RH, Sánchez-Sotelo J, Sperling JW. Cement-within-cement technique in revision reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(8):1448-1453. doi:10.1016/j.jse.2017.01.013.