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.
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.
If you have suggestions for topics you'd like us to address in this blog, please send an email to
shoulderarthritis@uw.edu
Use the "Topics" box to the right to find other posts of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.
See the countries from which our readers come on this post.
