Galatz details approach on humeral stem removal and shoulder revision surgery
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Due to the high incidence of complications associated with humeral stem removal, surgeons should familiarize themselves with bone and stem characteristics, as well as safety and extraction techniques, according to a recent presentation.
Leesa M. Galatz, MD, professor and chair of the Mount Sinai department of orthopedic surgery, discussed her technique for humeral stem removal and cemented revision at the Current Concepts in Joint Replacement Spring Meeting, which was held as a virtual meeting.
“I think it is really important when you are preparing yourself for a revision that you familiarize yourself with whatever stem is present and the patient,” Galatz said in her presentation. “Make sure you know the prosthesis; you know the bone quality. Where are your areas that are at risk for fracture? Know whether there is a cement restrictor down there.”
According to Galatz, removing a well-implanted cemented stem after revision shoulder arthroplasty requires careful planning and a variety of instruments to assist in an otherwise “difficult procedure.”
“Instruments are really important. I like a set of flexible osteotomes. These are very helpful for removing the prosthesis and cement interface,” Galatz said. “I like to loosen the cement prosthesis interface because I think – in that way – there is less risk of fracture, and then once you have the prosthesis out, it exposes that proximal cement.”
“Push vs. pull is really important. So, when I have a prosthesis, I always have the instruments for insertion present – just in case,” Galatz said.
Pushing the cement out reduces the risk of fracture, according to Galatz.
“Always when you are doing a revision and extracting a prosthesis, you need to be constantly vigilant about a fracture. If you have one, you are just going to fix it. It is not a disaster,” she said.
Galatz said she likes to approach the procedure in three steps.
“So, I use an impactor – ‘ex-pact’ isn't a word, but what I mean is push rather than pull,” Galatz added. “[I use] a humeral osteotomy and finally, the last resort, is a cortical window.”
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