The Extended Humeral Osteotomy for Revision Shoulder Arthroplasty: Results and Technique

Abstract Background Extraction of a well-fixed humeral stem during revision shoulder arthroplasty is challenging and can result in significant proximal humeral destruction. We introduce a refinement to osteotomy techniques, the extended humeral osteotomy (EHO), that facilitates complete extraction of the humeral component and cement mantle. Materials and Methods Twenty-five patients with failed shoulder arthroplasty who underwent an EHO for removal of a well-fixed humeral component between December 2008 and May 2018 were retrospectively identified. Twenty patients were available for final follow-up. Records and radiographs were reviewed for intraoperative and postoperative complications, preoperative and postoperative function, and patient reported outcome measures. Results Average follow-up was 65.6 months. All osteotomies healed. Of patients who were converted to reverse shoulder arthroplasty, 18/19 remained stable at final follow-up. From preop to final follow-up, mean forward elevation improved from 77 degrees to 109 degrees (p-value 0.013), ASES scores improved from 33.9 to 59.5 (p-value 0.003), and VAS scores improved from 6 to 3.1 (p-value 0.002). Complications related to the osteotomy occurred in two patients (10%). In one patient, the osteotomy was performed using improper instrumentation and created an intraoperative periprosthetic fracture which required immediate plate fixation. In one patient, irritation from a cable required cable removal at 1 year postop. There were no iatrogenic nerve injuries or known recurrent infections. Conclusion The extended humeral osteotomy is a safe and reproducible technique for complete extraction of well-fixed humeral prostheses and associated cement mantles in revision shoulder arthroplasty cases. Level of Evidence Level IV; Case Series; Treatment Study