Periprosthetic Humeral Fractures After Shoulder Arthroplasty

Kumar, Sanjay; Sperling, John W.; Haidukewych, George H.; Cofield, Robert H.

doi:10.2106/00004623-200404000-00003

Cited by 206 publications

(174 citation statements)

References 8 publications

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“…Although our study had a relatively large cohort of patients who underwent reverse shoulder arthroplasty, the number of patients was much smaller than in similar studies of periprosthetic fractures in patients having anatomic shoulder arthroplasty [1,15,19]. Furthermore, given the small number of intraoperative fractures that involved the metaphysis or diaphysis, it is difficult to draw conclusions regarding the optimal fixation method across all possible fracture types.…”

Section: Discussionmentioning

confidence: 91%

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What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

Wagner

Houdek

Elhassan

et al. 2015

Clin Orthop Relat Res

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Background With the increase in shoulder arthroplasty rates, the number of perioperative complications, such as periprosthetic fractures, continues to be a rise; however, the risk factors and incidence of intraoperative complications, such as fractures, during revision reverse shoulder arthroplasty are not well established. Questions/purposes We evaluated patients receiving a reverse shoulder arthroplasty to determine (1) the frequency and characteristics of intraoperative humerus fractures, (2) the risk factors for fracture, (3) the complications associated with treatment of fractures, and (4) clinical and functional outcomes after treatment. Methods Using one institution's total joint registry, we performed a retrospective analysis of medical records of 224 patients (230 shoulders) who underwent revision surgery to reverse shoulder arthroplasty, from 2005 to 2012, for failed total shoulder arthroplasty. Reverse shoulder arthroplasty was used when there was a deficient rotator cuff, prior instability, or deficient glenoid bone stock. Intraoperative periprosthetic humerus fractures occurred in 36 shoulders (16%) (36 patients). The clinical outcome analysis included 29 patients with a minimum 2-year clinical followup (mean followup, 3.1 years; range, 2.0À6.3 years). The control group consisted of 188 patients (194 shoulders), and it was used for risk-factor calculation; whereas only 150 patients (154 shoulders) in the control group had a minimum 2-year followup, and thus only 150 patients (154 shoulders) made up the comparators (controls) for outcome-analysis comparisons. Risk factors were assessed using univariate analysis with odds ratios (OR), whereas implant survival and complications were assessed using the Kaplan-Meier method. Results Three displaced and 33 nondisplaced fractures occurred during revision reverse total shoulder arthroplasties. Most of the fractures (81%) occurred during component removal of cemented (n = 11) and cementless (n = 25) components. Intraoperative fractures only were treated with stabilization of the prosthetic stem in 28 patients, while adjunctive internal fixation was used in eight patients. Risk of intraoperative periprosthetic fractures was increased by factors including female sex (n =18 women; OR, 2.41; range, 1.11À5.68; p = 0.03); history of instability (n = 27; OR, 2.65; range, 1.18À5.93; p = 0.02); and prior hemiarthroplasty (n = 22; OR, 2.34; range, 1.13À4.84; p = 0.03). There were two postoperative fractures in patients who had an intraoperative fracture and both were treated nonoperatively. Overall, three (8%) revision procedures were performed in patients with intraoperative fractures, with 2-and 5-year survivorship estimates of 94% and 85%, respectively, compared with 89% and 84%, respectively for patients without an intraoperative fracture (p = 0.45). At latest followup, patients

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Section: Discussionmentioning

confidence: 91%

“…Periprosthetic fractures associated with anatomic shoulder arthroplasty are relatively uncommon, with an incidence between 0.6% and 3% [1,6,8,9,12,15,18,19,[24][25][26].…”

Section: Introductionmentioning

confidence: 99%

What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

Wagner

Houdek

Elhassan

et al. 2015

Clin Orthop Relat Res

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“…Acceptable radiographic alignment is defined as within 20°of anterior/posterior angulation, 30°of varus/valgus alignment, and 20°of rotational alignment [62]. Nonoperative treatment can be carried out with a humeral fracture brace in these circumstances.…”

Section: Postoperative Fracturementioning

confidence: 99%

“…ORIF should be considered for type C fractures that do not meet acceptable radiographic alignment criteria. ORIF should also be considered for displaced, unstable fractures centered at the tip with a well-fixed humeral implant due to high nonunion rates when treated nonoperatively [62]. Fractures proximal to the tip with humeral stem loosening should be treated with a revision to a long-stem prosthesis that bypasses the fracture site by two cortical diameters.…”

Section: Postoperative Fracturementioning

confidence: 99%

Management of complications after revision shoulder arthroplasty

Rahmi

Jawa

2015

Curr Rev Musculoskelet Med

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Complications after revision shoulder arthroplasty are similar to those in the primary setting which include instability, fracture, bone loss, infection, nerve injury, and loosening. Unlike in the primary setting, however, the rate of complications for revisions is significantly greater and the management is more complex because of overlapping complications and limited treatment options. Furthermore, there is a paucity of evidence-based literature to direct the management options in these patients. The purposes of this review are to broadly outline the major complications that are seen in revision shoulder arthroplasty and to provide general principles on how to recognize and approach these complex cases.

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“…Arthroplasty in patients with rheumatoid arthritis often is complicated by the presence of bone densities in the osteopenic or osteoporotic range putting them at increased risk for periprosthetic fracture [4,5,9]. The incidence of periprosthetic humeral fractures after shoulder arthroplasty has been reported between 0.61% and 2.4% [2,3,8,13].…”

Section: Introductionmentioning

confidence: 99%

Ipsilateral Shoulder and Elbow Arthroplasty Using Custom Interlocking Prostheses

McConkey

Baslaim

Regan

2008

Clinical Orthopaedics &Amp; Related Research

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Ipsilateral shoulder and elbow arthritis is not an uncommon problem seen in patients of upper extremity surgeons. If arthroplasty is required in both joints, there is a significant risk of periprosthetic fracture resulting from the stress riser occurring between the implants. We report the placement of custom interlocking shoulder and elbow prostheses in a patient with rheumatoid arthritis. The elbow prosthesis with an uncemented humeral component was placed followed 18 months later by a custom-designed shoulder prosthesis. An internal strut between the two prostheses was created. Seven years postoperatively, the patient was asymptomatic with no radiographic signs of impending failure.

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Periprosthetic Humeral Fractures After Shoulder Arthroplasty

Cited by 206 publications

References 8 publications

What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

Management of complications after revision shoulder arthroplasty

Ipsilateral Shoulder and Elbow Arthroplasty Using Custom Interlocking Prostheses

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