BACKGROUND: While there have been numerous reports concerning
glenohumeral arthrodesis for many indications, there is little available
information specific to glenohumeral arthrodesis performed after failed
prosthetic shoulder arthroplasty. The purpose of this study was to report the
outcomes of glenohumeral arthrodesis in the setting of severe glenohumeral
bone loss and deltoid muscle and rotator cuff insufficiency following failed
prosthetic shoulder arthroplasty.
METHODS: We retrospectively reviewed clinical and radiographic data
on seven consecutive patients treated with glenohumeral arthrodesis following
a failed prosthetic shoulder arthroplasty between 1997 and 2004. The average
duration of clinical follow-up was four years (range, 1.5 to eight years).
RESULTS: Five of the seven patients demonstrated an intact fusion at
the time of the latest follow-up. Four of the seven patients had undergone
additional bone-grafting procedures in an effort to obtain union. Two of these
patients ultimately had a persistent nonunion despite the additional
procedures for bone-grafting and revision of the fixation hardware. Overall,
the average subjective clinical outcome score (Penn Shoulder Score) improved
significantly from 17 points (range, 8 to 33 points) to 58 points (range, 31
to 77 points) (p = 0.008). The most common complication was delayed union
requiring additional procedures for bone-grafting and revision of the fixation
CONCLUSIONS: Treatment of a failed prosthetic shoulder arthroplasty
with concomitant extensive glenohumeral bone loss and soft-tissue deficiencies
is extremely challenging. The results of this study suggest that glenohumeral
arthrodesis can yield satisfactory clinical outcomes. However, both the
patient and the surgeon should be aware of the complex nature of this surgery
and the frequent need for additional surgical procedures to obtain fusion.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.