Revision total shoulder arthroplasty for painful humeral head replacement with glenoid arthrosis

Hypothesis: After humeral head replacement, revision total shoulder arthroplasty may become necessary for painful glenoid arthrosis. The hypothesis of this study was revision surgery would significantly relieve the patients' pain. Materials and methods: This report retrospectively reviewed the results of revision total shoulder arthroplasty in seventeen patients with a painful humeral head replacement and glenoid arthrosis. The mean time interval to revision was 36.4 months (6-144) and the patients were followed for an average of 56.1 months (24-119). Outcomes were graded with the Neer classification. Results: There were 7 (41.2%) excellent, 5 (29.4%) satisfactory, and 5 (29.4%) unsatisfactory results. The visual analogue pain score decreased from 8.8 to 2.4, flexion improved from 73 degrees to 124, abduction from 63 to 115.6, and external rotation from 12.1 to 46.8. In 13 shoulders with sufficient data, the ASES score was 76.8 and the SST 9.5. It was necessary to revise the humeral stem in 12 of the 17 procedures, typically for poor stem position or improved exposure. Conclusion: Conversion of humeral head replacement to total shoulder arthroplasty can be accomplished with excellent results, but the surgery is complex and unsatisfactory results are frequent. Level of evidence: Level 4; Retrospective case series, no control group. (c) 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.