Salvage Procedures of the Shoulder: Glenohumeral Arthrodesis and Resection Arthroplasty
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REVIEW ARTICLE
Salvage Procedures of the Shoulder: Glenohumeral Arthrodesis and Resection Arthroplasty Antonio Arenas‑Miquelez1 · Lucas Arbeloa‑Gutierrez2 · Filippo Familiari3 · Julio de Pablos4 Received: 15 May 2020 / Accepted: 29 September 2020 © Indian Orthopaedics Association 2020
Abstract Background With the advances of modern medicine and technology there has been an increase of indications of shoulder reconstruction techniques and shoulder arthroplasty. Consequently, the number of complications and failures have increased in parallel. Not negligible number of cases are driven to an end-stage situation where salvage procedures, such as glenohumeral arthrodesis (GHA) and shoulder resection arthroplasty (SRA), are the only remaining solution. Methods The current literature on glenohumeral arthrodesis and shoulder resection arthroplasty was reviewed to determine the indications, surgical technique, complications and outcomes. The electronic search was conducted using the MEDLINE and EMBASE databases and the strategies used were “glenohumeral arthrodesis”, “glenohumeral fusion”, “shoulder arthrodesis” and “shoulder resection arthroplasty”. Results Indications for glenohumeral arthrodesis (GHA) include brachial plexus injury, tumor resections, chronic infection, failed prosthetic arthroplasty, persistent refractory instability or pseudoparalysis of the shoulder with combined irreparable rotator cuff and deltoid injuries. GHA provides good stability, pain resolution, although function is markedly compromised and relying mostly on scapulothoracic joint. The gold standard surgical technique continues to be open shoulder arthrodesis and still has a high complication rate. Shoulder resection arthroplasty (SRA) indications have evolved through the years, being nowadays a salvage procedure for recalcitrant infection of shoulder arthroplasty the main indication. Shoulder function after SRA is often severely compromised, but has a high infection rate resolution. SRA is not technically demanding and complications are rare, being the persistence of infection the most common one. Discussion Despite GHA and SRA having negative connotations, in selected patients, these procedures can diminish pain, resolve persistent infections and provide an acceptable shoulder function. Hence, they should be retained as part of the treatment algorithm for complex shoulder pathology. Keywords Salvage procedure · Glenohumeral arthrodesis · Shoulder resection arthroplasty · Indications · Complications
Introduction
* Antonio Arenas‑Miquelez [email protected] 1
Shoulder and Elbow, Orthopaedics, Macquarie University Hospital, Suite 303, 2 Technology Place, Sydney, NSW 2109, Australia
2
Department of Orthopaedic and Traumatology, García-Orcoyen Hospital, Estella, Navarra, Spain
3
Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro, Italy
4
Advanced Reconstructive Osseous Surgery, San Juan de Dios Hospital, Pamplona, Spain
With the advances of modern medicine and technology there has been an
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