Stemmed Hemiarthroplasty Research Articles

Trends in prevalence and implant types in the Nova Scotia Joint Database Registry between 2005 and 2021.

The aim of this study is to evaluate the change in incidence rate of shoulder arthroplasty, indications, and surgeon volume trends associated with these procedures between January 2003 and April 2021 in the province of Nova Scotia, Canada. A total of 1,545 patients between 2005 and 2021 were analyzed. Patients operated on between 2003 and 2004 were excluded due to a lack of electronic records. Overall, 84.1% of the surgeries (n = 1,299) were performed by two fellowship-trained upper limb surgeons, with the remainder performed by one of the 14 orthopaedic surgeons working in the province. Total shoulder arthroplasty (TSA) was the most frequent procedure (32.17%; n = 497), followed by stemmed hemiarthroplasty (SHA) (27.7%; n = 428). The most frequent indication for primary shoulder arthroplasty was degenerative osteoarthritis (58.1%; n = 882), followed by acute proximal humerus fracture in 15.11% (n = 245), and rotator cuff arthropathy in 14.18% (n = 220). The overall rate of revision was 7.7% (2.8% to 11.2%). The number of TSAs and reverse shoulder arthroplasties (RSAs) has been increasing since 2016. The amount of revision cases is proportional to the number of operations performed in the same year throughout the study period. The incidence of shoulder arthroplasty in the Maritime Provinces has increased over the last 16 years. Revision rates are similar the those found in other large database registries. Reverse shoulder arthroplasty prevalence has increased since 2016.

Analysis on revision rates of shoulder arthroplasty at a single referral center in Canada

BackgroundThe aim of the present report is to study a historic cohort on revision rates and indications from our local shoulder arthroplasty registry over the last 16 years. MethodsAn overall population of 1545 in the period of 2005 and 2021 was analyzed, identifying 149 shoulder arthroplasty revisions, from which 26.1% were resurfacing hemiarthroplasty, 40.9% stemmed hemiarthroplasty, 14% total shoulder arthroplasty (TSA), and 18.7% reverse shoulder arthroplasty (RSA). ResultsThe overall revision rate identified in our population was 7.7% (n = 149/1545). This was distributed between stemmed hemiarthroplasty with a revision rate of 14.2% (n = 61/428), 13.4% (n = 39/291) for resurfacing hemiarthroplasty, 8.6% (n = 28/324) for RSA, and 4.2% (n = 21/497) for TSA. Glenoid erosion was the main revision indication in 38.9% of the cases, followed by aseptic loosening in 19.46% and instability in 15.44%. Only 12 cases (8.05%) were revised due to infection and 2 of those required two-staged procedure. The most common implant type used in revisions was RSA with 41.61% followed by TSA in 34.23% of the cases. Thirty patients (20.1%) required more than one revision procedure and 43% (n = 13/30) of them were revised to RSA. Acute fracture (adjusted odds ratio = 2.67, 95% confidence interval 1.66-4.29; P < .01) and avascular necrosis (adjusted odds ratio = 2.18, 95% confidence interval 1.03-4.63; P .043) were associated with an increased risk of revision surgery. DiscussionThe main implants revised were stemmed and unstemmed hemiarthroplasties. RSA was the most frequent implant used for revisions.

Primary stemmed shoulder hemiarthroplasty for proximal humerus fractures in active patients aged ≤40 years: average 20 years of follow-up

BackgroundAlthough open reduction and internal fixation is a standard treatment for the management of severe proximal humeral fractures, it is associated with high risk for humeral head necrosis. Therefore, stemmed hemiarthroplasty (SHA) may be successfully used for older patients, but the expected long-term outcomes for young, active patients remain unclear. Therefore, in this study, we report the long-term clinical outcomes of SHA of the shoulder in young, active patients aged <40 years. MethodsBetween 1986 and 2003, we investigated 11 shoulders of 11 patients (all male) for primary SHA of the shoulder. Five patients received cemented hemiarthroplasty. The average age was 28.6 years (range, 17–40 years), and the average follow-up was 20.5 years (range, 18–26 years). Fractures were 2-part (dislocation of anatomical neck fracture) in 3 patients, 3-part in 2 patients, and 4-part in 6 patients. Clinical function was assessed using the Japanese Orthopaedic Association score and Constant score. Acromiohumeral interval, prosthetic loosening, superior migration, and glenoid erosion were compared between the immediate postoperative and 5-year, 10-year, and most recent (final) follow-up radiographs. ResultsThe mean Japanese Orthopaedic Association and Constant scores at final follow-up were 87.5 ± 10.6 points (range, 58–100) and 82.8 ± 12.7 points (range, 48–95), respectively. There was no change in clinical score at the final follow-up compared with scores at 5 or 10 years after surgery. Clinical outcome was poor in 1 patient (absorption of greater tuberosity) regarding range of motion. No patient had prosthetic loosening or periprosthetic fracture. Three patients had mild or moderate glenoid erosion. The acromiohumeral interval gradually decreased with time. ConclusionThere was good long-term survival of primary SHA (average, 20.2 years). No long-term concerns were identified in terms of implant loosening or severe osteoarthritis of the glenoid, despite the young age of the patients at implant (<40 years). However, poor clinical results were found in older patients with regard to absorption and malunion of the greater tuberosity. In addition, there remain substantial concerns regarding progressive glenoid erosion and the outcomes of revision to a more standard arthroplasty.

Resurfacing hemiarthroplasty versus stemmed hemiarthroplasty for glenohumeral osteoarthritis: a meta-analysis

BackgroundThough total shoulder arthroplasty (TSA) has been an acknowledged treatment option for glenohumeral osteoarthritis, resurfacing hemiarthroplasty (RHA) and stemmed hemiarthroplasty (SHA) may be preferred in some circumstances by surgeons, especially for treating young or active patients. However, decision-making between the RHA and SHA is controversial. Therefore, we conducted a meta-analysis to systematically compare two surgical procedures in terms of postoperative functional outcomes, range of motion (ROM), pain relief, complication rates, risk of revision.MethodsThe PubMed, Embase, Web of Science and Cochrane Library were searched from inception to January 1, 2020, for all articles that compared the clinical effectiveness and safety of RHA with SHA. All eligible studies were selected based on certain screening criteria. Two investigators independently conducted the quality assessment and extracted the data. Fixed-effect and random-effect models were used for pooled results according to the degree of heterogeneity. All statistical analyses were performed by employing Stata software 14.0.ResultsA total of six comparative studies involving 2568 shoulders (1356 RHA and 1212 SHA) were included in the final analysis. Patients were followed up for at least 1 year in each study. Pooled results showed that RHA was associated with a better visual analog scale (SMD 0.61, p = 0.001) but higher revision rates (OR 1.50, p = 0.016) when compared to SHA. There were no significant differences in functional outcomes, such as Constant-Murley score (SMD 0.06, P = 0.878), American Shoulder and Elbow Surgeons score (SMD 0.05, P = 0.880), Western Ontario Osteoarthritis of the Shoulder index (SMD 0.43, p = 0.258) and quick-Disabilities of the Arm, Shoulder and Hand score (SMD 0.06, p = 0.669). In addition, no differences were observed in forward flexion (SMD 0.16, p = 0.622), external rotation (SMD -0.17, P = 0.741) and overall complication rates (OR 1.42, p = 0.198).ConclusionThis is the first meta-analysis to investigate the clinical efficacy and safety of RHA in comparison with SHA for the treatment of glenohumeral osteoarthritis. The results demonstrated that the two surgical techniques were equivalent in terms of postoperative functional outcomes and complication rate. However, RHA provided greater pain relief but posed a higher risk for revision than SHA. More high-quality studies with long-term follow up are warranted to give more convincing evidence.

Patients undergoing shoulder arthroplasty for failed nonoperative treatment of proximal humerus fracture have low implant survival and low patient-reported outcomes: 837 cases from the Danish Shoulder Arthroplasty Registry

Background and purpose — When nonoperative treatment of proximal humerus fracture (PHF) fails, shoulder arthroplasty may be indicated. We investigated risk factors for revision and evaluated patient-reported outcome 1 year after treatment with either stemmed hemiarthroplasty (SHA) or reverse total shoulder arthroplasty (RTSA) after previous nonoperative treatment of PHF sequelae.Patients and methods — Data were derived from the Danish Shoulder Arthroplasty Registry and included 837 shoulder arthroplasties performed for PHF sequelae between 2006 and 2015. Type of arthroplasty, sex, age, and surgery period were investigated as risk factors. The Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome (0–100, 0 indicates worst outcome). Cox regression and linear regression models were used in the statistical analyses.Results — 644 patients undergoing SHA and 127 patients undergoing RTSA were included. During a mean follow-up of 3.7 years, 48 (7%) SHA and 14 (11%) RTSA were revised. Men undergoing RTSA had a higher revision rate than men undergoing SHA (hazard ratio [HR] 6, 95% confidence interval [CI] 2–19). 454 (62%) patients returned a complete WOOS questionnaire. The mean WOOS score was 53 for SHA and 53 for RTSA. Patients who were 65 years or older had a better WOOS score than younger patients (mean difference 7, CI 1–12). Half of patients had WOOS scores below 50.Interpretation — Shoulder arthroplasty for PHF sequelae was associated with a high risk of revision and a poor patient-reported outcome. Men treated with RTSA had a high risk of revision.

Low Survival Rates of Stemmed Hemiarthroplasty and Reverse Arthroplasty After Treatment for Proximal Humerus Fracture Sequelae. A Register-Based Study from the Nordic Arthroplasty Register Association

Low Survival Rates of Stemmed Hemiarthroplasty and Reverse Arthroplasty After Treatment for Proximal Humerus Fracture Sequelae. A Register-Based Study from the Nordic Arthroplasty Register Association

Low revision rate despite poor functional outcome after stemmed hemiarthroplasty for acute proximal humeral fractures: 2,750 cases reported to the Danish Shoulder Arthroplasty Registry

Background and purpose — The revision rate of stemmed hemiarthroplasty (SHA) for acute proximal humeral fractures is low, but does not necessarily reflect the functional outcome. We report the revision rate of SHA for acute proximal humeral fractures and the proportion of arthroplasties that are not revised despite low functional outcome scores.Patients and methods — The Danish Shoulder Arthroplasty Registry was used to identify all patients with a proximal humeral fracture that was treated with a SHA between January 1, 2006 and December 31, 2015. Information on demographics, surgical procedures, and revisions was collected by the registry. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 1 year was used as functional outcome score. We converted the score to a percentage of a maximum score with 100 being the best.Results — 2,750 SHAs in 2,719 patients were included. Mean age was 72 years (SD 11); 79% were women. Mean WOOS at 1 year was 55 (SD 26). A total of 101 (4%) arthroplasties were revised, and the 10-year cumulative implant survival rate was 95%. The Cox regression model showed a statistically significant impact on implant survival of age, but not of sex or arthroplasty brand. A WOOS score below 30 and 50 was reported in 11% and 25% of patients, respectively.Interpretation — We found a high implant survival rate, but also a high proportion of patients with a low functional outcome score 1 year after surgery.

Anatomical total shoulder arthroplasty used for glenohumeral osteoarthritis has higher survival rates than hemiarthroplasty: a Nordic registry-based study

To report the10-year survival rates of different shoulder arthroplasty types used for glenohumeral osteoarthritis. Data from 2004 to 2013 was prospectively collected by the national shoulder arthroplasty registers in Denmark, Norway and Sweden and merged into a harmonized dataset under the umbrella of the Nordic Arthroplasty Register Association. The common dataset included data that all three registers could deliver and where consensus regarding definitions could be made. Revision was defined as removal or exchange of any component or the addition of a glenoid component. The cumulative survival rates at 10 years after resurfacing hemiarthroplasty (RHA) (n=1,923), stemmed hemiarthroplasty (SHA) (n=1,587) and anatomical total shoulder arthroplasty (TSA) (n=2,340) were 0.85, 0.93 and 0.96 respectively (P<0.001, Log rank test). RHA (HR: 2.5; CI 1.9-3.4, P<0.001) and SHA (HR: 1.4; CI 1.0-2.0, P<0.04) had an increased risk of revision compared to TSA. Gender, age and period of surgery were included in the Cox regression model. For patients below 55 years, the 10-year cumulative survival rates were 0.75 (RHA, n=354), 0.81 (SHA, n=146), and 0.87 (TSA, n=201). Anatomical TSA had the highest implant-survival rate. Young patients had, independently of the arthroplasty type, lower implant-survival rates. The treatment of young patients with end-stage osteoarthritis remains a challenge.

Revision after shoulder replacement for acute fracture of the proximal humerus

Background and purpose — For more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus.Patients and methods — This study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013.Results — There were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9–2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6–5.9) for RSA with SHA as reference. The relative risk of revision for patients who were less than 75 years of age was 2.8 (95% CI: 2.0–3.8) compared to older patients.Interpretation — Revision after shoulder arthroplasty for acute fractures was rare. Survival rates were similar between SHA and RSA, but RSA had a statistically significant and clinically relevant higher risk of revision because of infection.

Outcome of Revision Shoulder Arthroplasty After Resurfacing Hemiarthroplasty in Patients with Glenohumeral Osteoarthritis.

Patients are often treated with a resurfacing hemiarthroplasty in the expectation that the bone-preserving design facilitates revision should the need for a revision arthroplasty arise. The aim of this study was to report the outcome of patients with glenohumeral osteoarthritis who underwent revision shoulder arthroplasty after resurfacing hemiarthroplasty. We reviewed all patients with osteoarthritis reported to the Danish Shoulder Arthroplasty Registry from 2006 to 2013. There were 1,210 primary resurfacing hemiarthroplasties, of which 107 cases (9%) required a revision surgical procedure, defined as the removal or exchange of the humeral component or the addition of a glenoid component. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate outcome at 1 year. The median WOOS of revision arthroplasty after failed resurfacing hemiarthroplasty was 62 points (interquartile range, 40 to 88 points). Of the 80 cases that had follow-up, 33 (41%) had an unacceptable outcome, defined as a WOOS of ≤50 points. Of the 107 cases that required a revision surgical procedure, 11 arthroplasties (10%) required a further revision surgical procedure. The resurfacing hemiarthroplasty was revised to a stemmed hemiarthroplasty (n = 39), anatomic total shoulder arthroplasty (n = 31), or reverse shoulder arthroplasty (n = 30). In 7 cases, the revision arthroplasty design was unknown. The median WOOS of patients who underwent revision stemmed hemiarthroplasty (48 points) was significantly inferior (p = 0.002) to that of patients who underwent primary stemmed hemiarthroplasty (75 points); the median WOOS of patients who underwent revision anatomic total shoulder arthroplasty (74 points) was also significantly inferior (p = 0.007) to that of patients who underwent primary anatomic total shoulder arthroplasty (93 points). However, the median WOOS of patients who underwent revision reverse shoulder arthroplasty (68 points) was not significantly different (p = 0.66) from that of patients who underwent primary reverse shoulder arthroplasty (77 points) used in the treatment of osteoarthritis. The outcome of revision shoulder arthroplasty after failed resurfacing hemiarthroplasty was variable and, in many cases, disappointing. It is important that resurfacing hemiarthroplasty is used for the correct indications and with adequate technique and skill. When resurfacing hemiarthroplasty is used in the treatment of osteoarthritis, revision cannot be counted upon as a fallback. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

(i) Surgical approaches for shoulder arthroplasty

Abstract Shoulder arthroplasty is most commonly performed via a deltopectoral (DP) or anterosuperior (AS) approach, and several modifications of each have been described. Both approaches can be used for resurfacing, stemless and stemmed hemiarthroplasty, anatomic total shoulder arthroplasty (TSA), and reverse shoulder arthroplasty (RSA). This article aims to give a practical guide to performing both approaches, and a summary of the related evidence.

Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis

Background and purpose — There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision, and we compare outcome after resurfacing hemi-arthroplasty (RHA) and stemmed hemi-arthroplasty (SHA).Patients and methods — We used data from the national Danish Shoulder Arthroplasty Registry and included patients with RA who underwent shoulder arthroplasty in Denmark between 2006 and 2010. Patient-reported outcome was obtained 1-year postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), and rates of revision were calculated by checking revisions reported until December 2011. The patient-reported outcome of RHA was compared to that of SHA using regression analysis with adjustment for age, sex, and previous surgery.Results — During the study period, 167 patients underwent shoulder arthroplasty because of rheumatoid arthritis, 80 (48%) of whom received RHA and 34 (26%) of whom received SHA. 16 patients were treated with total stemmed shoulder arthroplasty (TSA), and 24 were treated with reverse shoulder arthroplasty (rTSA). 130 patients returned a completed questionnaire, and the total mean WOOS score was 63. The cumulative 5-year revision rate was 7%. Most revisions occurred after RHA, with a revision rate of 14%. Mean WOOS score was similar for RHA and for SHA.Interpretation — This study shows that shoulder arthroplasty, regardless of design, is a good option in terms of reducing pain and improving function in RA patients. The high revision rate in the RHA group suggests that other designs may offer better implant survival. However, this should be confirmed in larger studies.

Resurfacing hemiarthroplasty compared to stemmed hemiarthroplasty for glenohumeral osteoarthritis: a randomised clinical trial.

The aim of this study was to conduct a randomised, clinical trial comparing stemmed hemiarthroplasty and resurfacing hemiarthroplasty in the treatment of glenohumeral osteoarthritis. A total of 40 shoulders (35 patients) were randomised to stemmed hemiarthroplasty or resurfacing hemiarthroplasty and evaluated three and 12months postoperatively using the Constant-Murley score (CMS) and Western Ontario Osteoarthritis of the Shoulder (WOOS) index. There were no statistically significant differences in age, gender or pre-operative scores except for WOOS at baseline. Two patients were lost to follow-up. Significant improvements in CMS and WOOS were observed at oneyear after both arthroplasty designs. At oneyear, the mean CMS was 48.9 (range 6-80) after resurfacing hemiarthroplasty and 59.1 (range 0-88) after stemmed hemiarthroplasty {mean difference 10.2 [95% confidence interval (CI) -3.3 to 23.6], P = 0.14}. The mean WOOS was 59.2 (range 5.2-100.0) and 79.4 (range 12.8-98.6), respectively [mean difference 20.2 (95% CI 3.4-36.9), P = 0.02]. No major complications occurred and there were no revisions. The effects of resurfacing hemiarthroplasty tended to be inferior to those of stemmed hemiarthroplasty. It is unclear whether this reflects a real difference in effect or baseline differences due to the limited number of randomised patients. We suggest there is a need for a larger, more definitive trial.

Outcome and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis

This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.

Patient-reported outcome and risk of revision after shoulder replacement for osteoarthritis

Purpose — We used patient-reported outcome and risk of revision to compare hemiarthroplasty (HA) with total shoulder arthroplasty (TSA) and stemmed hemiarthroplasty (SHA) with resurfacing hemiarthroplasty (RHA) in patients with glenohumeral osteoarthritis.Patients and methods — We included all patients reported to the Danish Shoulder Arthroplasty Registry (DSR) between January 2006 and December 2010. 1,209 arthroplasties in 1,109 patients were eligible. Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome 1 year postoperatively. For simplicity of presentation, the raw scores were converted to a percentage of the maximum score. Revision rates were calculated by checking reported revisions to the DSR until December 2011. WOOS and risk of revision were adjusted for age, sex, previous surgery, and type of osteoarthritis.Results — There were 113 TSAs and 1096 HAs (837 RHAs and 259 SHAs). Patients treated with TSA generally had a better WOOS, exceeding the predefined minimal clinically important difference, at 1 year (mean difference 10, p < 0.001). RHA had a better WOOS than SHA (mean difference 5, p = 0.02), but the difference did not exceed the minimal clinically important difference. There were no statistically significant differences in revision rate or in adjusted risk of revision between any of the groups.Interpretation — Our results are in accordance with the results from other national shoulder registries and the results published in systematic reviews favoring TSA in the treatment of glenohumeral osteoarthritis. Nonetheless, this registry study had certain limitations and the results should be interpreted carefully.

The routine use of a hydroxyapatite coated femoral stemmed hemiarthroplasty for the treatment of displaced femoral neck fractures: Early results and follow-up from a district general hospital

The routine use of a hydroxyapatite coated femoral stemmed hemiarthroplasty for the treatment of displaced femoral neck fractures: Early results and follow-up from a district general hospital

Reconstruction of the proximal humerus with a composite of extracorporeally irradiated bone and endoprosthesis following excision of high grade primary bone sarcomas

Functional reconstruction of the shoulder joint following excision of a malignant proximal humeral tumour is a difficult proposition. Eleven patients with primary osteosarcoma or Ewing's sarcoma underwent reconstruction with a composite of extra-corporeally irradiated autograft with the addition of a long stemmed hemiarthroplasty. At a mean follow-up of 5.8 years two patients had died from disseminated disease and one patient had undergone amputation for local recurrence. The eight patients with a surviving limb were examined clinically and radiographically. The mean Toronto Extremity Salvage Score was 74 and Musculo-Skeletal Tumour Society score 66. Rotation was well preserved but abduction (mean 32 degrees ) and flexion (40 degrees ) were poor. There was a high rate of secondary surgery, with five out of eleven patients requiring re-operation for complications of reconstruction surgery. Radiographic estimate of graft remaining at follow up was 71%. There were no infections, revisions or radiographic failures. Whilst the reconstructions were durable in the medium term, the functional outcome was no better than with other reported reconstructive methods. The composite technique was especially useful in subtotal humeral resections, allowing preservation of the elbow joint even with very distal osteotomy. Bone stock is restored, which may be useful for future revision surgery in this young group of patients.

Outcome of stemmed shoulder hemi-arthroplasty revision

We report our experience of revision of failed stemmed shoulder hemi-arthroplasty for causes other than infection. Seventeen revisions were followed for a minimum of 2 years. Fifteen cases were revised for symptomatic glenoid erosion. Sixteen were revised to a total shoulder arthroplasty and one to a cuff tear arthropathy head. The mean visual analogue pain score following revision surgery was reduced from 6.7 to 3.2 (P = 0.008). However the Constant-Murley and the Association of Shoulder and Elbow Surgeons scores failed to improve significantly. We conclude that revision surgery for failed stemmed shoulder hemi-arthroplasty improves pain but not function.