Vertical Incomplete Humerotomy (VIH) with Suture Loop Cerclages for Humeral Stem Extraction and Reimplantation in Revision of Shoulder Arthroplasty.

Abstract

Extraction of well-fixed humeral implants during revision shoulder arthroplasty is difficult and prone to complications, especially humeral fracture (up to 12% in anatomical stem revision and 30% in reversed stem revision). To prevent this complication, we perform a Vertical Incomplete Humerotomy (VIH) and use cerclages with suture loops and Nice Knots for fixation. To describe the VIH technique with suture cerclage fixation, report the perioperative complications, and evaluate the radiological and clinical results outcomes. We performed a retrospective monocentric study of consecutive patients who underwent revision shoulder arthroplasty with a VIH at a single institution (2007-2022). A straight longitudinal humeral osteotomy was created posterior and parallel to the bicipital groove. This allows for extraction of the humeral stem and cement mantle. Osteotomy closure was performed with 2 to 6 cerclages with suture loops (Nice Loop, Tornier-Stryker, Kalamazoo, MI, USA) and a non-sliding knot ("Nice knot"). The primary outcome was assessment of intraoperative and postoperative complications. The secondary outcome was osteotomy healing at 6 months and clinical results at two years. A cohort of 47 patients (mean age of 67.34 years, range 33-86) with a mean follow-up was 37.9 months who underwent revision shoulder with VIH were analyzed. There were 21 Hemiarthroplasty (HA), 11 Total Shoulder Arthroplasty (TSA) and 15 Reversed Shoulder Arthroplasty (RSA). There were 5 revisions to TSA, 26 revisions to RSA, 3 humeral stem revision and 13 revisions to spacers secondary to periprosthetic joint infection (PJI). One intraoperative humeral fracture occurred during stem removal. No postoperative complication related to the humerotomy occurred and no patients required surgical revision secondary to the humerotomy. Primary osteotomy healing and callus formation were evident in all cases by 6 months. In 12 cases of PJI, a second stage revision was performed, there were 3 reinterventions (2 instability and 1 infection). At the last follow-up, 82% of patients were satisfied after the intervention; the mean Subjective Shoulder Value (SSV) was 58%, and the VAS score was 3.4/10. (1) VIH facilitates extraction of well-fixed cemented or uncemented humeral components and prevents iatrogenic humeral fractures in revision shoulder arthroplasty, and (2) Suture fixation, using suture loops (Nice Loop; Tornier-Stryker, Kalamazoo, MI, USA) and a non-sliding knot ("Nice knot"), provides constant bone healing and is an alternative to wire for cerclage fixation of humerotomy.