Shoulder arthroplasty in patients with prior mastectomy for breast cancer.

Twenty women, all of whom had undergone mastectomy for breast cancer and 11 of whom had undergone radiation therapy, underwent shoulder arthroplasty. Two of these patients subsequently underwent resection arthroplasty for delayed infection and uncontrollable instability. Seventeen patients were available for follow-up, which averaged 4.6 years (range, 23 months to 13 years). There was significant improvement in pain (P < .0001), with no pain in 8, slight pain in 7, occasional moderate pain in 1, and moderate pain in 1 of the patients. A significant improvement in active motion occurred only in external rotation. Active elevation increased 7 degrees, from 92 degrees to 99 degrees; external rotation increased 17 degrees, from 25 degrees to 42 degrees; and internal rotation increased 1 level, to L3. All patients were pleased with their results. Complications were frequent. Apart from the 2 patients who underwent reoperation, 5 patients with preoperative lymphedema experienced exacerbation of their edema and 2 others developed new lymphedema. The edema returned to prearthroplasty levels or resolved in all patients by 5 months. In addition, antecubital vein thrombosis occurred in 1 patient, delayed long head of biceps rupture in 2 patients, and late rotator cuff tearing in 3 patients. In carefully selected patients, shoulder arthroplasty can be effective in pain reduction, but little increase in range of motion should be expected. Complications (often involving soft tissues) are frequent. New or increased arm edema can occur; however, edema resolved or returned to prearthroplasty levels in our patients.