Wednesday, December 26, 2012

Glenoid component failure in total shoulder arthroplasty.

Glenoid component failure in total shoulder arthroplasty. JBJS

In 2008 we published this article, the findings of which seem as applicable today as they were 4 years ago. Glenoid component failure remains the most common complication of total shoulder arthroplasty. "Glenoid components fail as a result of their inability to replicate essential properties of the normal glenoid articular surface to achieve durable fixation to the underlying bone, to withstand repeated eccentric loads and glenohumeral translation, and to resist wear and deformation. The possibility of glenoid component failure should be considered whenever a total shoulder arthroplasty has an unsatisfactory result. High-quality radiographs made in the plane of the scapula and in the axillary projection are usually sufficient to evaluate the status of the glenoid component. Failures of prosthetic glenoid arthroplasty can be understood in terms of failure of the component itself, failure of seating, failure of fixation, failure of the glenoid bone, and failure to effectively manage eccentric loading. An understanding of these modes of failure leads to strategies to minimize complications related to prosthetic glenoid arthroplasty."At the time of the writing of this article, however, we did not appreciate the possible role of low grade bacterial infection in glenoid component loosening.

We did note particular problems with metal-backed glenoid components, including  the risk of dissociation of the polyethylene surface from its metal backing and accelerated glenoid polyethylene wear. 


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