Total shoulder replacement: x-ray evidence of loosening

In yesterday's post, we discussed radiolucent lines (RLL's) and the possible role of heat generated in the preparation of the glenoid in their creation. Here are two x-rays showing RLL's from our artilce on
failure of the polyethylene glenoid component.

In the first, an axillary view, one can see the metal humeral component at upper left. The small metal oval in the center of the picture is a marker in the plastic glenoid component. The plastic glenoid component itself cannot be seen on x-ray. Below this oval is the keel of the component and surrounding cement shown in white, surrounded by a darker area indicated by the small arrows. This darker zone is the radiolucent line. The larger arrow points to a radiolucent line underneath the face of the plastic glenoid component.

In the second x-ray, an anteroposterior view of the shoulder, the arrows point to a radiolucent line between cement on beneath the glenoid component  (the thin white curved line) and the bone that normally would support the glenoid component. The darker area between the cement and the humeral prosthesis is the location of the face of the glenoid component.

These radiolucent lines seen on x-ray represent areas where there is no bone, cement, or glenoid prosthesis. Instead the area is filled with fibrous tissue that does not securely fix the component to the bone. As pointed out in previous posts, these lines are often progressive and lead to symptoms of glenoid component loosening.

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