Revision of the humeral component for aseptic loosening in arthroplasty of the shoulder

Between 1976 and 2004, 38 revision arthroplasties ( 35 patients) were performed for aseptic loosening of the humeral component. The mean interval from primary arthroplasty to revision was 7.1 years ( 0.4 to 16.6). A total of 35 shoulders ( 32 patients) were available for review at a mean follow-up of seven years ( 2 to 19.3). Pre-operatively, 34 patients ( 97%) had moderate or severe pain; at final follow-up, 29 ( 83%) had no or only mild pain ( p < 0.0001). The mean active abduction improved from 88 degrees to 107 degrees degrees ( p < 0.01); and the mean external rotation from 37 degrees to 46 degrees ( p = 0.27). Excellent or satisfactory results were achieved in 25 patients ( 71%) according to the modified Neer rating system. Humeral components were cemented in 29, with ingrowth implants used in nine cases. There were 19 of standard length and 17 were longer ( two were custom replacements and are not included). Bone grafting was required for defects in 11 humeri. Only two glenoid components were left unrevised. Intra-operative complications included cement extrusion in eight cases, fracture of the shaft of the humerus is two and of the tuberosity in four. There were four re-operations, one for recurrent humeral loosening, with 89% survival free of re-operations at ten years. Revision surgery for aseptic loosening of the humeral component provides reliable pain relief and modest improvement of movement, although there is a substantial risk of intra-operative complications. Revision to a total shoulder replacement gives better results than to a hemiarthroplasty.