CORR Insights(®): What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

Abstract

T he frequency of shoulder arthroplasty in today’s population has increased, in part due to the growing number of older patients with degenerative and traumatic disorders of the shoulder, as well as the extension of arthroplasty solutions to younger patients who feel they have exhausted reasonable nonsurgical alternatives. As a consequence, more revision shoulder arthroplasties should be anticipated. From its introduction for narrow indications into the United States more than a decade ago, reverse shoulder arthroplasty has emerged as the preferred treatment, in many instances, for failed shoulder arthroplasties that require prosthetic revision. However, the severity and frequency of complications with this approach are well described. It also is clear that patients undergoing reverse shoulder arthroplasty as part of a revision shoulder arthroplasty do not do as well as those undergoing reverse total shoulder arthroplasty for cuff-tear arthropathy, failed rotator cuff repairs, and posttraumatic sequelae. Part of this difference may derive from the need, in many instances, to remove the existing humeral prosthesis. The paper by Wagner et al. supports this idea; 16% (36 of 230) patients undergoing revision to a reverse total shoulder arthroplasty experienced an intraoperative humerus fracture, and most of these fractures occurred during removal of the humeral component. While the authors mention that the frequency of intraoperative fractures was higher during revision arthroplasty with a reverse versus anatomic component, the reader is left to speculate the reasons for the difference. Curiously, only in the presence of hemiarthroplasty, as opposed to total shoulder arthroplasty, was the risk of intraoperative fracture increased. Perhaps the majority of hemiarthroplasties were performed for fracture treatment, and resulted in variable patterns and degrees of tuberosity union, all of which may add complexity and risk to component explantation. This CORR Insights is a commentary on the article ‘‘What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?’’ by Wagner and colleagues available at: DOI: 10.1007/ s11999-015-4448-x. The author certifies that he, or any members of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999015-4448-x. D. N. Collins MD (&) Orthopaedic Surgeon, Arkansas Specialty Orthopaedics, 600 S McKinley St., Little Rock, AR 72205-5219, USA e-mail: maddoccolli@aol.com CORR Insights Published online: 27 August 2015 The Association of Bone and Joint Surgeons1 2015