The role of index humeral stem length and convertibility in outcomes after
revision to reverse shoulder arthroplasty
#MMPMID41346432
Chang M
; Kane L
; Rizk AA
; Fellheimer H
; Getz CL
; Lazarus MD
; Williams GR
; Namdari S
Shoulder Elbow
2025[Dec]; ? (?): 17585732251395312
PMID41346432
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BACKGROUND: The development of modular platform humeral stems has introduced
multiple variables to consider during revision of a failed anatomic shoulder
arthroplasty to reverse (RTSA). While studies have demonstrated that retention of
a well-fixed and well-positioned stem is associated with less blood loss, faster
surgical time, and lower complication rates, stratification based on stem length
has been limited. This study investigates clinical outcomes after revision RTSA
in relation to humeral component conversion versus explantation. METHODS: This
was a retrospective case series of consecutive patients from 2014 to 2021 who
underwent revision from anatomic shoulder arthroplasty or hemiarthroplasty to
RTSA. Variables included indication for revision, estimated blood loss (EBL),
changes in hemoglobin/hematocrit, operative time, need for osteotomy or cortical
window, intraoperative/postoperative complications, and reoperations. Outcomes
were also compiled for forward elevation, external rotation, visual analog scale
pain, American Shoulder and Elbow Surgeons standardized assessment, and Single
Assessment Numeric Evaluation scores. Patient-reported outcome measures were
collected at 1 year and at >2 years. The cohort was divided into three
categories, (1) stem retention, (2) short-stem explant, and (3) standard stem
explant. RESULTS: Final analysis included 72 patients. Time from index to
revision surgery was significantly longer in the standard explant group (2.2 vs.
2.5 vs. 4.5 years, p?=?0.02). A cortical window or osteotomy was performed in 11
of 31 (35.5%) standard length explants and none of the conversions or short stems
(p?=?0.001). EBL was higher among standard explants (150 vs. 150 vs. 200?mL,
p?=?0.003). There was a similar trend in operative time (125 vs. 108 vs. 154?min,
p?=?0.02). Postoperative patient-reported outcome measures were not significantly
different among groups. There was, however, a significant decrease in forward
elevation (134 vs. 126 vs. 112 degrees, p?=?0.03) and external rotation (31 vs.
35 vs. 24 degrees, p?=?0.02) among the standard explants. There were no
differences among groups with regard to rates of intraoperative or postoperative
complications or reoperations. CONCLUSION: In this review of patients undergoing
revision RTSA, there was a clinically relevant increase in blood loss, surgical
time, and a decrease in ultimate range of motion when explanting standard length
stems as compared to short-stem or convertible implants. While there are
continued trends towards short-stem and canal-sparing implants for anatomic
shoulder arthroplasty, the relative benefit of convertibility in the revision
setting warrants continued evaluation. LEVEL OF EVIDENCE: III - retrospective
cohort design.
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