Accessibility Tools


Shoulder arthroplasty has undergone rapid advances in recent years, with more options available to the practicing orthopedist. From hemiarthroplasty to either conventional or reverse total shoulder replacement, consistently good to excellent results have been reported for the treatment of proximal humerus fracture, end-stage degenerative arthritis, and rotator cuff arthropathy. However, as indications expand and more shoulder arthroplasties are performed, an increase in the number of failed reconstructions and required revisions is expected.

The extent to which a component must be removed during revision shoulder arthroplasty depends on the mode of failure. Failures can result from glenoid erosion, glenoid component loosening, instability, infection, component malpositioning, and, seldom, humeral component loosening. Given that the humeral component represents an uncommon mechanism for failure, revision can become particularly challenging when a well-fixed prosthesis must be removed. Extensive bone ingrowth or a large, intact cement mantle can make humeral stem extraction precarious. The humerus differs from the femur in that the cortical bone is much thinner, creation of a safe window or L-shaped osteotomy is more difficult, and loss of tuberosities can lead to severe dysfunction. Without a safe and reliable technique for stem removal, the proximal humerus may be unnecessarily fractured or denuded of bone stock.

This was demonstrated by Wall and colleagues with a 24.1% iatrogenic fracture rate in revision procedures. Sperling and Cofield described an anterior or medial cortical windowing technique for facilitating humeral stem removal. However, they reported a 20% rate of intraoperative fracture associated with this procedure and noted that, with refinement, further techniques could be developed to lower the fracture rate significantly. Carroll and colleagues as well as Petersen and Hawkins alluded to an osteotomy procedure for extraction of a humeral stem, but neither group described the technique in the literature.

In this article, we report a representative revision arthroplasty that involved a novel technique, vertical humeral osteotomy, which allowed for safe and effective humeral stem extraction with no need for distal windows, no proximal bone loss, and no need for a long-stemmed prosthesis.

Read Full Publication

Locations & Directions