Conversion of painful hemiarthroplasty to total shoulder arthroplasty: long-term results.

The purpose of this study was to evaluate the outcome after conversion of painful hemiarthroplasty to total shoulder arthroplasty (TSA). Sixteen consecutive patients who underwent revision TSA for failed humeral head replacement (HHR) at our institution from 1988 to 2000 were evaluated. The mean interval from the time of HHR to revision TSA was 3.5 years (range, 11 months to 10.5 years). At a mean 5.5-year follow-up (range, 2-14 months), the results were excellent in 3 of 15 (20%), satisfactory in 5 of 15 (33%), and unsatisfactory in 7 of 15 (47%). The mean American Shoulder and Elbow Surgeons score was 73.6 (range, 46.7-95) out of a possible 100. The mean visual analog pain score was 2.4 (range, 0-6) out of 10. Evidence of posterior glenoid erosion was found in 64% (7/11) of these patients. On the basis of the complexity of the surgery and the 47% unsatisfactory rate, we conclude that revision of a failed HHR to a TSA is a salvage procedure whose results are inferior to those of primary TSA.

Complications after hemiarthroplasty for fractures of the proximal humerus.

Humeral head replacement is frequently used in the treatment of selected fractures of the proximal humerus. This technique is usually successful in terms of pain relief and patient satisfaction. However, complications may occur and can adversely affect outcome. Careful preoperative planning, meticulous surgical technique, and appropriate postoperative rehabilitation are the best methods to promote a successful result. Potential complications and methods to avoid them at initial surgery should be reviewed.