The Journal of Bone and Joint Surgery (American). 2009;91:30-37.
doi:10.2106/JBJS.H.01249
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Glenohumeral Arthrodesis After Failed Prosthetic Shoulder Arthroplasty

Surgical Technique

Jason J. Scalise, MD1 and Joseph P. Iannotti, MD, PhD2

1 The CORE Institute, 3010 West Agua Fria Freeway, Suite 100, Phoenix, AZ 85027. E-mail address: jason.scalise{at}thecoreinstitute.com
2 Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A-41, Cleveland, OH 44195. E-mail address: iannotj{at}ccf.org

Investigation performed at the Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 90-A, pp. 70-7, January 2008

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commercial entities (DePuy Johnson and Johnson and Tornier) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

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 hardware.

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.


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