Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up
Background: Revision reverse total shoulder arthroplasty (rTSA) of a previously cemented humeral component is challenging. In hip arthroplasty, the cement-within-cement (CwC) technique has been well described as an effective option. However, for shoulder arthroplasty there remains a paucity of data...
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Elsevier
2025-02-01
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| Series: | JSES Reviews, Reports, and Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666639124001184 |
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| author | Rodrigo de Marinis, MD John W. Sperling, Jr. Erick M. Marigi, MD Ausberto Velasquez Garcia, MD Eric R. Wagner, MD Joaquin Sanchez-Sotelo, MD, PhD |
| author_facet | Rodrigo de Marinis, MD John W. Sperling, Jr. Erick M. Marigi, MD Ausberto Velasquez Garcia, MD Eric R. Wagner, MD Joaquin Sanchez-Sotelo, MD, PhD |
| author_sort | Rodrigo de Marinis, MD |
| collection | DOAJ |
| description | Background: Revision reverse total shoulder arthroplasty (rTSA) of a previously cemented humeral component is challenging. In hip arthroplasty, the cement-within-cement (CwC) technique has been well described as an effective option. However, for shoulder arthroplasty there remains a paucity of data investigating this technique. The purpose of this study was to determine the mid-term outcomes of patients who underwent a revision rTSA utilizing the CwC for management of the humeral component. Methods: Between 2005 and 2021, 68 revision rTSA using the CwC technique with a minimum of 2 years clinical follow-up were identified from a single institution joint registry database. Revised implants consisted of 38 (55.9%) hemiarthroplasties, 22 (32.4%) anatomic total shoulder arthroplasties, and 8 (11.8%) rTSA. A total of 12 (17.6%) shoulders required an osteotomy (corticotomy or window) to assist with extraction of the cemented stem. The mean follow-up after revision was 5.4 years (range, 2-16 years). Surgical complications, reoperations, revisions, and implant survivorship were assessed. Results: Of the 12 shoulders that required an osteotomy for component removal, 11 (91.7%) were healed. At final follow-up, the overall complication rate was 26.9%. The most common complication was fracture or fragmentation of the greater tuberosity (20.6%, n = 13) with 10 (76.9%) cases showing signs of healing at final follow-up. The overall survivorship free of revision surgery was 88.2% at 2 and 80.9% at 5 years, respectively. The most frequent causes of re-revision surgery were aseptic glenoid component loosening (n = 4) and instability (n = 4), with only 2 (2.9%) patients developing humeral component loosening (at 2 and 5 years, respectively). Male sex was associated with an increased risk of revision surgery (hazard ratio [HR], 3.52 [95% confidence interval [CI] 1.22-10.18]; P = .02) and complications (HR, 3.56 [95% CI, 1.40-9.07]; P = .008). The grade of postoperative lucent lines at the humerus (HR, 1.35 [95% CI, 1.04-1.74]; P = .02) and glenoid (HR, 1.59 [95% CI, 1.22-2.10]; P = .001) also correlated with an increased risk of re-revision surgery. Conclusion: The CwC technique is a reliable option for revising previously cemented humeral components in revision rTSA. Although a low rate of humeral component loosening was observed, higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability, which are not directly related to CwC technique but to revision surgery in general. |
| format | Article |
| id | doaj-art-90121bf42cb3412dbe59a1c6968dc9ce |
| institution | Kabale University |
| issn | 2666-6391 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
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| series | JSES Reviews, Reports, and Techniques |
| spelling | doaj-art-90121bf42cb3412dbe59a1c6968dc9ce2025-01-06T04:09:01ZengElsevierJSES Reviews, Reports, and Techniques2666-63912025-02-015116Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-upRodrigo de Marinis, MD0John W. Sperling, Jr.1Erick M. Marigi, MD2Ausberto Velasquez Garcia, MD3Eric R. Wagner, MD4Joaquin Sanchez-Sotelo, MD, PhD5Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile; Shoulder and Elbow Unit, Hospital Dr. Sótero del Río, Santiago, ChileDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USADepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USADepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Clinica Universidad de los Andes, Department of Orthopedic Surgery, ChileDivision of Upper Extremity Surgery, Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USADepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Corresponding author: Joaquin Sanchez-Sotelo, MD, PhD, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.Background: Revision reverse total shoulder arthroplasty (rTSA) of a previously cemented humeral component is challenging. In hip arthroplasty, the cement-within-cement (CwC) technique has been well described as an effective option. However, for shoulder arthroplasty there remains a paucity of data investigating this technique. The purpose of this study was to determine the mid-term outcomes of patients who underwent a revision rTSA utilizing the CwC for management of the humeral component. Methods: Between 2005 and 2021, 68 revision rTSA using the CwC technique with a minimum of 2 years clinical follow-up were identified from a single institution joint registry database. Revised implants consisted of 38 (55.9%) hemiarthroplasties, 22 (32.4%) anatomic total shoulder arthroplasties, and 8 (11.8%) rTSA. A total of 12 (17.6%) shoulders required an osteotomy (corticotomy or window) to assist with extraction of the cemented stem. The mean follow-up after revision was 5.4 years (range, 2-16 years). Surgical complications, reoperations, revisions, and implant survivorship were assessed. Results: Of the 12 shoulders that required an osteotomy for component removal, 11 (91.7%) were healed. At final follow-up, the overall complication rate was 26.9%. The most common complication was fracture or fragmentation of the greater tuberosity (20.6%, n = 13) with 10 (76.9%) cases showing signs of healing at final follow-up. The overall survivorship free of revision surgery was 88.2% at 2 and 80.9% at 5 years, respectively. The most frequent causes of re-revision surgery were aseptic glenoid component loosening (n = 4) and instability (n = 4), with only 2 (2.9%) patients developing humeral component loosening (at 2 and 5 years, respectively). Male sex was associated with an increased risk of revision surgery (hazard ratio [HR], 3.52 [95% confidence interval [CI] 1.22-10.18]; P = .02) and complications (HR, 3.56 [95% CI, 1.40-9.07]; P = .008). The grade of postoperative lucent lines at the humerus (HR, 1.35 [95% CI, 1.04-1.74]; P = .02) and glenoid (HR, 1.59 [95% CI, 1.22-2.10]; P = .001) also correlated with an increased risk of re-revision surgery. Conclusion: The CwC technique is a reliable option for revising previously cemented humeral components in revision rTSA. Although a low rate of humeral component loosening was observed, higher rates of complications and re-revision surgery were observed over time secondary to aseptic glenoid component loosening and instability, which are not directly related to CwC technique but to revision surgery in general.http://www.sciencedirect.com/science/article/pii/S2666639124001184Revision shoulder arthroplastyCemented humeral componentReverse total shoulder arthroplastyImplant survivorshipPostoperative complicationsCement within cement |
| spellingShingle | Rodrigo de Marinis, MD John W. Sperling, Jr. Erick M. Marigi, MD Ausberto Velasquez Garcia, MD Eric R. Wagner, MD Joaquin Sanchez-Sotelo, MD, PhD Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up JSES Reviews, Reports, and Techniques Revision shoulder arthroplasty Cemented humeral component Reverse total shoulder arthroplasty Implant survivorship Postoperative complications Cement within cement |
| title | Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up |
| title_full | Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up |
| title_fullStr | Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up |
| title_full_unstemmed | Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up |
| title_short | Cement-within-cement technique in revision reverse total shoulder arthroplasty: complications, reoperations, and revision rates at 5-year mean follow-up |
| title_sort | cement within cement technique in revision reverse total shoulder arthroplasty complications reoperations and revision rates at 5 year mean follow up |
| topic | Revision shoulder arthroplasty Cemented humeral component Reverse total shoulder arthroplasty Implant survivorship Postoperative complications Cement within cement |
| url | http://www.sciencedirect.com/science/article/pii/S2666639124001184 |
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