Use of a high-speed pencil-tip burr for removal of well-fixed humeral components in revision shoulder arthroplasty.

BACKGROUND: Removal of a well-fixed humeral stemmed component during revision total shoulder arthroplasty (TSA) remains technically challenging and carries a risk of intra-operative fracture and bone loss. Various osteotomy-based methods have been described to facilitate extraction, though each carries its own morbidity. The high-speed pencil-tip burr offers an alternative method for controlled disruption of the bone-implant or cement-bone interface, potentially reducing complications and bone loss. The purpose of this study was to evaluate radiographic and clinical outcomes following revision TSA utilizing a high-speed pencil-tip burr for removal of well-fixed humeral components.

METHODS: A retrospective review of revision TSAs performed by a single surgeon between 2007 and 2023 was conducted. Clinical and radiographic data were collected via retrospective chart review in 2025. Patients were included if a high-speed pencil-tip burr was used for removal of a well-fixed humeral stem in the setting of revision TSA. Demographics, revision indications, adjunct instruments, and complications were collected from operative reports and institutional registry data. Clinical outcomes included the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Single Assessment Numeric Evaluation, and visual analog scale (VAS) scores for pain and function. Cases in which an intra-operative fracture occurred were reviewed for radiographic healing and functional recovery.

RESULTS: A total of 128 revision TSAs met inclusion criteria. The most common indications for revision were rotator cuff tears (56.3%) and glenoid loosening (36.7%), with multiple indications present in some patients. At a mean clinical follow-up of 43.4 ± 39.2 months, all patient-reported outcome measures improved significantly. Twenty-seven patients (21.1%) sustained intra-operative humeral fractures, including greater tuberosity (n = 15), surgical neck (n = 6), lesser tuberosity (n = 4), and humeral shaft (n = 2) fractures. Radiographically, 21 of 27 fractures (77.8%) demonstrated healing, with all non-greater tuberosity fractures healing and all cases of displacement (n = 4) or resorption (n = 2) occurring in greater tuberosity fractures. When compared with patients without fracture, those sustaining an intra-operative humeral fracture demonstrated no significant differences in post-operative American Shoulder and Elbow Surgeons, Simple Shoulder Test, Single Assessment Numeric Evaluation, VAS pain, VAS function, or range of motion.

CONCLUSION: Use of a high-speed pencil-tip burr for removal of well-fixed humeral components during revision TSA allows reliable stem extraction without osteotomy, with an intra-operative fracture rate comparable to other series, favorable radiographic healing, and significant improvement in clinical and patient-reported outcomes.