Saturday, November 24, 2012

Failings of a reverse total shoulder

Three years ago a patient had a reverse total shoulder. Post operative films shown below

Within the first month the glenosphere dissociated from the baseplate requiring revision as shown below.

With a year or so, he developed pain and clunking in his shoulder and had these radiographic findings (problem is subtle, can you see it?)

 He came to see us at which time we obtained these films.

 Did you notice the dissociation of the humeral tray from the stem. It turns out that this tray is made of Titanium.

 In this cases, the stem of the tray had fatigued and fractured.

We were able to obtain a Chrome-Cobalt humeral tray and used it in our revision, shown below. We also resected the heterotopic bone and cultured the wound for Propionibacterium. Results pending.

In the current wave of enthusiasm for implanting reverse total shoulders, it is important to recognize that this is a technically demanding procedure and that each implant system has its own nuances for fixation of the glenoid base plate, glenosphere, humeral stem, humeral tray and humeral poly. This case also demonstrates that the forces at the articulation are large - enough to result in fatigue fracture of the stem of the tray. It also points out the importance of understand the metallurgy of the implant.


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