From the Center for Shoulder, Elbow and Sports Medicine, Department of Orthopedic Surgery, New York-Presbyterian/Columbia University Medical Center, New York, NY.
J Am Acad Orthop Surg. 2019 Jan 15;27(2):39-49. doi: 10.5435/JAAOS-D-17-00051.
A variety of reasons exist for failure of arthroplasty performed for management of proximal humerus fracture. Revision surgery for these failures is complex and has a high likelihood of inferior outcomes compared with primary arthroplasty. Successful management requires consideration of various modes of failure including tuberosity malunion or resorption, rotator cuff deficiency, glenoid arthritis, bone loss, component loosening, stiffness, or infection. Although revision to a reverse shoulder arthroplasty is an appealing option to address instability, rotator cuff dysfunction, and glenoid arthritis, there are concerns with higher complication rates and inferior results compared with primary reverse replacement. Any treatment plan should appropriately address the cause for failure to optimize outcomes.
人工关节置换术治疗肱骨近端骨折失败的原因有很多。与初次置换术相比，这些失败的翻修手术较为复杂，且结果较差的可能性较高。成功的治疗需要考虑各种失败模式，包括结节愈合不良或吸收、肩袖缺损、盂肱关节炎、骨量丢失、假体松动、僵硬或感染。虽然翻修为反式肩关节置换术是解决不稳定、肩袖功能障碍和盂肱关节炎的一种有吸引力的选择，但与初次反式置换相比，其并发症发生率较高，结果较差。任何治疗方案都应适当解决失败的原因，以优化结果。
