Factors associated with humeral stem extraction difficulty in revision shoulder arthroplasty

Q2 Medicine

JSES International Pub Date : 2025-09-01 DOI:10.1016/j.jseint.2025.05.025

Nabile Himer MD , Philippe Clavert MD, PhD , Amine Mellal MD , Emmanuel Baulot MD, PhD , Stefan Bauer MD , Maxime Antoni MD

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Abstract

Background

Removal of the humeral stem during revision shoulder arthroplasty can be challenging and is associated with complications. The primary objective of this study was to identify risk factors for intraoperative humerus fractures or the need for a humerotomy. The secondary objective was to determine factors associated with the use of a standard or long revision stem.

Methods

In this retrospective monocentric study, a total of 127 consecutive shoulder arthroplasty revisions (53 men, 74 women, mean age 68 ± 11 years) were included. All included patients underwent a complete revision of the humeral component. Preoperative periprosthetic fractures were excluded. Assessed risk factors included patient-related factors, the etiology and characteristics of the primary prosthesis, time between the primary arthroplasty and revision, and the etiology of the revision. All risk factors were evaluated through a multivariate analysis with logarithmic regression.

Results

A humerotomy was required in 7.9% (10/127), while an iatrogenic humerus fracture occurred in 24.4% (31/127) of cases, resulting in a total of 32.3% (41/127). Factors associated with difficulties during stem extraction included chronic infection (P = .001), the presence of a long stem (P = .04), and the use of a cemented stem (P = .01). Age and gender were not associated. During revision, a short, standard-length, and long stem were implanted in 7.1% (9/127), 55.1% (70/127), and 37.8% (48/127), respectively. Factors associated with the use of a standard or long revision stem included increased age (P = .006), lower preoperative external rotation (P = .028), a standard (P < .0001) or long (P = .002) primary stem, a cemented primary stem (P = .006), a longer interval between primary arthroplasty and revision (P = .025), and the occurrence of a fracture or the need for a humerotomy (P = .016), particularly in cases of diaphyseal localization (P = .009).

Conclusion

Difficulties and complications extracting the humeral stem were encountered in 32.3% of cases in our series. Chronic infection as the cause of revision and the use of a long or cemented stem were significant associated factors.

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改良肩关节置换术中肱骨柄拔出困难的相关因素

背景：肩关节翻修成形术中肱骨干的切除具有挑战性，并伴有并发症。本研究的主要目的是确定术中肱骨骨折或需要肱骨切开术的危险因素。第二个目标是确定与使用标准或长修订系统相关的因素。方法在这项回顾性单中心研究中，共纳入127例连续肩关节置换术翻修患者（男性53例，女性74例，平均年龄68±11岁）。所有纳入的患者都接受了肱骨部分的完整翻修。排除术前假体周围骨折。评估的危险因素包括患者相关因素、原发性假体的病因和特征、原发性关节置换术和翻修之间的时间以及翻修的病因。通过对数回归的多变量分析评估所有危险因素。结果7.9%（10/127）行肱骨切开术，24.4%（31/127）发生医源性肱骨骨折，32.3%（41/127）行肱骨切开术。与拔牙困难相关的因素包括慢性感染（P = .001）、长茎（P = .04）和使用骨水泥（P = .01）。年龄和性别无关。翻修时，7.1%（9/127）、55.1%（70/127）和37.8%（48/127）植入短、标准长度和长茎。与使用标准或较长的翻修柄相关的因素包括年龄增加（P = 0.006）、术前较低的外旋度（P = 0.028）、标准（P < 0.0001）或较长（P = 0.002）一期翻修柄、骨水泥一期翻修柄（P = 0.006）、一期关节置换术和翻修间间隔较长（P = 0.025）、发生骨折或需要肱骨切开术（P = 0.016），特别是在骨干定位的情况下（P = 0.009）。结论本组病例中有32.3%的肱骨干取出困难和并发症。慢性感染是翻修的原因，使用长柄或骨水泥是重要的相关因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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