Revision for humeral stem loosening: a systematic review

Humeral loosening (HL) is an uncommon indication for revision shoulder arthroplasty. This systematic review describes patient characteristics (prosthetic type removed, reimplanted, and septic vs. aseptic loosening status), re-revision rate, and outcomes following revision surgery for a loose humeral stem.

An electronic database search of PubMed, Scopus, Embase, and Cochrane was conducted accordant to the Preferred Reporting Items for Systematic Reviews and Meta-analyses method. Studies that reported information on patients who had revision arthroplasty due to HL and reported their postrevision outcomes were included in this review.

Our review included 13 studies, from which 119 revision cases due to HL were extracted. The prostheses subtypes revised for HL were 48.7% (58/119) anatomic total shoulder arthroplasties (TSAs), 46.2% (55/119) reverse shoulder arthroplasties (RSAs), and 5.0% (6/119) hemiarthroplasties (HAs). The implants used to revise patients with HL were 52.2% (59/113) RSAs, 35.4% (40/113) HAs, and 12.4% (14/113) TSAs. Septic loosening occurred in 11.7% (14/119) of the cases. Ninety-seven cases provided details regarding subsequent revisions, of which 28.9% (28/97) were re-revised. The following outcome scores were available: mean satisfaction rate was 71.4% (n = 49), the mean total American Shoulder and Elbow Surgeons score was 52.5 (range 30-66) (n = 28), and the mean Constant score was 40.3 (range 34-41.3) (n = 14).

The most revised implants for HL were TSAs and RSAs. Reverse shoulder arthroplasties were the most common implants used for revision, followed by HAs. Aseptic loosening accounted for most cases, suggesting that infection is rarely the primary cause of HL. There is a pronounced risk of re-revision for recurrent HL. The irregular reporting of validated outcome scores makes it difficult to draw definitive conclusions regarding the treatments of these patients.