Shoulder arthroplasty in patients with prior mastectomy for breast cancer

Twenty women, all of whom had undergone mastectomy for breast cancer and 11 of whom had undergone radiation therapy underwent shoulder arthroplasty. T wo of these patients subsequently underwent resection arthroplasty for dela yed infection and uncontrollable instability Seventeen patients were availa ble for Follow-up, which averaged 4.6 years (range, 23 months to 13 years). There was significant improvement in pain (P <.0001), with no pain in 8, s light pain in 7, occasional moderate pain in 7, and moderate pain in 7 of t he patients. A significant improvement in active motion occurred only in ex ternal rotation. Active elevation increased 7<degrees>, from 92 degrees to 99 degrees; external rotation increased 17 degrees, from 25 degrees to 42 d egrees; and internal rotation increased 7 level, to L3. All patients were p leased with their results. Complications were frequent. Apart from the 2 pa tients who underwent reoperation, 5 patients with preoperative lymphedema e xperienced exacerbation of their edema and 2 others developed new lymphedem a. The edema returned to prearthroplasty levels or resolved in all patients by 5 months. In addition, antecubital vein thrombosis occurred in I patien t, delayed long head of biceps rupture in 2 patients, and late rotator cuff tearing in 3 patients. In carefully selected patients, shoulder arthroplas ty can be effective in pain reduction, but little increase in range of moti on should be expected. Complications (often involving soft tissues) are Fre quent. New or increased arm edema can occur; however, edema resolved or ret urned to prearthroplasty levels in our patients.