Do preoperative radiographs help predict intraoperative challenges in revision surgery after previous shoulder hemiarthroplasty?

David E O'Briain; Peter Simon; Kaitlyn N Christmas; Miguel A Diaz; A Vincent Hess 2nd; Eric G Hernandez-Ortiz; Thomas Sellers; Paul B McLendon; Mark A Mighell; Mark A Frankle

doi:10.1016/j.jse.2019.04.013

Do preoperative radiographs help predict intraoperative challenges in revision surgery after previous shoulder hemiarthroplasty?

J Shoulder Elbow Surg. 2019 Jun;28(6S):S161-S167. doi: 10.1016/j.jse.2019.04.013.

Authors

Affiliations

¹ Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
² Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
³ Foundation for Orthopaedic Research and Education, Tampa, FL, USA.
⁴ Florida Orthopaedic Institute, Tampa, FL, USA.
⁵ Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
⁶ Florida Orthopaedic Institute, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.

PMID: 31196511
DOI: 10.1016/j.jse.2019.04.013

Abstract

Background: This study compares preoperative radiographic evaluation with intraoperative video and explant data in patients undergoing revision of a hemiarthroplasty.

Methods: From 2004 to 2017, 182 shoulder hemiarthroplasties underwent revision to reverse shoulder arthroplasty for symptomatic failure. Preoperative radiographs were evaluated for stem fixation, stability, and glenohumeral registry. Intraoperative videos (n = 48) were evaluated for humeral component stability and bone loss after humeral stem extraction. All explants (n = 83) were reviewed for humeral head wear patterns and extraction artifacts (EAs).

Results: A well-fixed stem was reliably identified on radiographs as well fixed (true-negative rate, 95%). Of cemented implants, 94% (97 of 103) were radiographically stable and 90% (18 of 20) were stable on intraoperative video. Significant proximal humeral bone loss was identified after cemented stem extraction in 83% of cases, and severe EAs were noted in 28% (14 of 50). Of uncemented implants, 95% (75 of 79) were radiographically stable and 96% (24 of 25) were operatively stable. Significant proximal humeral bone loss was identified after extraction in 36% of cases (9 of 25) (P = .001). Severe EAs were seen in 13% of explanted stems (3 of 23). Eccentrically worn humeral head explants were associated with eccentric glenohumeral registry in 84% of cases (P = .0075).

Conclusion: Preoperative radiographs for revision of a failed hemiarthroplasty help identify well-fixed stems and predict humeral bone loss during extraction. Cemented stems will have more EAs and result in greater bone loss than uncemented stems. Glenohumeral registry can help to predict humeral head wear. Eccentric registry leads to eccentric humeral head wear in 84% of cases.

Keywords: Revision shoulder arthroplasty; extraction artifact; failed hemiarthroplasty; humeral bone loss; reverse shoulder arthroplasty; shoulder hemiarthroplasty.

Publication types

Comparative Study

MeSH terms

Arthroplasty, Replacement, Shoulder
Artifacts
Device Removal
Female
Hemiarthroplasty
Humans
Humeral Head / diagnostic imaging*
Intraoperative Period
Male
Preoperative Period
Reoperation*
Shoulder Joint / diagnostic imaging*
Shoulder Joint / surgery*
Shoulder Prosthesis
Tomography, X-Ray Computed
Video Recording