Endoprosthetic replacement of the proximal humerus in revision shoulder arthroplasty

Abstract

Reconstruction of proximal humeral bone defects in the setting of shoulder revision arthroplasty by implantation of amodular humeral component. Severe segmental humeral bone defects in revision total shoulder arthroplasty, after tumor resection, trauma, pathological fractures, post-infectious or after failed osteosynthesis. Acute or chronic local infections, large diaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3months). Removal of the implant using an extended deltopectoral approach. Periarticular arthrolysis with preservation of neurovascular structures. Resection of the meta-diaphyseal bone and reconstruction of the humeral length with the help of different extension sleeves and amodular humeral component. Soft tissue management is crucial, especially with reverse shoulder arthroplasty. Three weeks postoperatively immobilization in ashoulder sling, active assisted movement therapy by gradual pain-adapted increase of movement, muscle coordination, and strength. The results of 11 consecutive patients treated with amodular humeral component due to afailed shoulder arthroplasty between 2008 and 2016 were evaluated retrospectively. Mean length of reconstruction was 100 mm. Due to recurrent dislocations one patient required revision and conversion to areverse component. No cases of aseptic loosening or periprosthetic infection were observed.