Periprosthetic Fractures Associated with Primary Total Shoulder Arthroplasty and Primary Humeral Head Replacement

Singh, Jasvinder A.; Sperling, John W.; Schleck, Cathy D.; Harmsen, William S.; Cofield, Robert H.

doi:10.2106/jbjs.j.01945

Cited by 84 publications

(62 citation statements)

References 22 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%

“…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%

“…Although not studied as comprehensively as postoperative fractures, the incidence, risk factors, and outcomes associated with intraoperative periprosthetic fractures during anatomic shoulder arthroplasty has been characterized [1,19]. The rate of intraoperative fractures during revision primary anatomic arthroplasty is as much as 3.3% [1].…”

Section: Introductionmentioning

confidence: 99%

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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%

See 1 more Smart Citation

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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“…In several studies some intra-operative fractures deserved special mention due to the difference in mechanism of injury, risk factors and treatment. In total shoulder arthroplasty risk factors involved are female sex, ASA (Classification 3 or 4) and diagnosis of post-traumatic arthritis (14). In revision hip arthroplasty, intra-operative femur fracture has an incidence of 12% despite 1.7% of primary THA; risk factors are: female sex, age over 65, cementless stems (5,15).…”

Section: Causes and Risk Factorsmentioning

confidence: 99%

Periprosthetic fractures: epidemiology and current treatment

Capone

Congia

Civinini

et al. 2017

ccmbm

110

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SummaryPeriprosthetic fractures are becoming increasingly frequent due to aging population and growing number of total joint replacements involving joints different from hip and knee, such as shoulder and elbow. The treatment of these fractures still represents one of the major challenges for the orthopedic surgeon. Despite all efforts to understand and treat these patients, high rate of failure and mortality are still reported. In this review, the epidemiology of periprosthetic fractures, risk factors and results of surgical treatment are disclosed. Moreover, we propose a treatment algorithm based on the findings of the New Unified Classification System.

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“…Lee et al have shown that reaming the diaphysis causes a stress riser even before the component is inserted since the canal is often reamed asymmetrically [16]. Periprosthetic humerus fractures are due to the stress riser in diaphyseal humerus bone [17]. Moving the stress riser to proximal metaphyseal bone may decrease the rate of fracture or at minimum preserves distal diaphyseal bone stock for potential fixation or revision surgery.…”

Section: Introductionmentioning

confidence: 99%

Total shoulder arthroplasty: are the humeral components getting shorter?

Harmer

Throckmorton

Sperling

2016

Curr Rev Musculoskelet Med

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Each generation of total shoulder arthroplasy has improved on the previous. The newest humeral component innovation is shortening the humeral component or eliminating the stem entirely to rely on stemless fixation in the humeral metaphysis. This offers theoretical advantages of preserved bone stock, less stress shielding, eliminating the diaphyseal stress riser, ease of stem removal at revision, and humeral head placement independent from the humeral shaft axis. There are a number of short term cohorts that have shown low complication rates and outcomes similar to previous generations of stemmed humeral components. Longer term and better designed studies are needed in order for short stems and stemless components to become the standard of care.

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Periprosthetic Fractures Associated with Primary Total Shoulder Arthroplasty and Primary Humeral Head Replacement

Cited by 84 publications

References 22 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?

Periprosthetic fractures: epidemiology and current treatment

Total shoulder arthroplasty: are the humeral components getting shorter?

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