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Glenohumeral Arthrodesis May Benefit Patients After Failed Prosthetic Shoulder Arthroplasty

Patients who have had a prosthetic shoulder arthroplasty (shoulder replacement) have a generally high success rate after 15 years at about 87 percent. However, many patients do need to have revision surgeries because of infection in the shoulder, loosening of the hardware, or other problems.

In some cases, the patients' shoulders are too damaged for further revision surgery and another option is needed. The authors of this study wanted to assess the function and pain status of patients who had a arthrodesis, or fusion of the joint instead of a revision surgery.

Researchers looked through files of patients who had had an arthrodesis performed following failure of the replacement. They found 7 patients who fit the criteria for the study. The patients ranged in age from 20 to 65 years and the follow-ups after surgery ranged from 18 to 96 months.

The researchers found that 5 of the patients had a union of the joint at the most recent follow-up recorded. However, only 3 patients were successful with the fusion after one surgery. The remaining 2 needed further surgeries for additional bone grafting. Two patients did not have a union (non-union).

Assessments of shoulder function and shoulder pain were done before surgery, after surgery, and during follow-ups. The researchers used the Penn Shoulder Score to assess pain, satisfaction, and function. The scores improved from 17 points (out of a possible 100) to and average of 58 points among the patients.

The authors point out that the small group size and the fact that this was a retrospective study are weaknesses of the study, however, they conclude that as a salvage procedure, glenohumeral arthrodesis is appropriate for carefully selected patients when other revision surgeries are not options.

References: Jason J. Scalise, MD, and Joseph P. Iannotti, MD, PhD. Glenohumeral Arthrodesis After Failed Prosthetic Shoulder Arthroplasty. In The Journal of Bone & Joint Surgery. January 2008. Vol. 90. No. 1. pp. 70-77

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