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My husband was a football player years ago in college and damaged his rotator cuff pretty badly without doing anything about it. Now he's had a shoulder replacement with a special reverse implant. BUT the darn bone around the implant has come loose and fractured. What are the chances he can come out of this as good as he went in? He's had no pain and perfectly good use of his arm.

That is a bit of bad news. But perhaps we can offer some encouraging words. According to a recently published study following patients with humeral shaft fractures after shoulder replacement, return of prefracture motion and function is possible. Treatment of these fractures usually requires surgery either by removing the implant and replacing it or using hardware to hold everything together until healing takes place. This second option is a surgical procedure referred to as open reduction and internal fixation (ORIF). In the study we mentioned, two surgeons from the Florida Orthopaedic Institute in Tampa, Florida reported on the results of 36 patients. Each one was surgically treated for a humeral shaft fracture after they had a shoulder replacement. One thing that makes this study unusual is the fact that like your husband, some of their patients had a reverse shoulder prosthesis. Up until now, only single case reports or small case series have provided any information on humeral fractures associated with reverse shoulder arthroplasty. This study reports on outcomes (bone healing, shoulder motion) after surgical treatment for these patients. The reverse shoulder prosthesis is made up of two parts. The humeral component replaces the humeral head, or the ball of the joint. The glenoid component replaces the socket of the shoulder, which is actually part of the scapula. In the "normal" artificial shoulder prosthesis, the glenoid prosthesis is a shallow socket made of plastic and the humeral component is a metal stem attached to a metal ball that nearly matches the anatomy of the normal shoulder. In the reverse shoulder replacement, the ball and the socket are reversed. Again, just like your husband anyone who has a severely damaged (and irreparable) rotator cuff is the most likely candidate for the reverse arthroplasty. This type of shoulder replacement provides pain relief as well as a stable, functional shoulder. Of the 36 patients in the study, 35 had complete healing of the fracture and a return of shoulder motion equal to their prefracture level of motion. The first group who had the open reduction and internal fixation (ORIF) had good fracture healing without any stem loosening in the follow-up period. The second group (patients who had the implant removed and replaced) showed X-ray evidence of femoral shaft loosening, which is why they ended up having a revision arthroplasty instead of the ORIF. They were also able to return to their preinjury level of motion and function. In fact, some of these patients were even better than before the fracture developed. There was evidence that the loosening of the stem component was the reason the fracture developed in the first place. Your husband's surgeon is the best one to advise you as to the recommended treatment and expected outcomes. Without a lot of evidence, it does look like what has been reported so far is quite favorable.

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