Sunday, July 28, 2013

Failed hemiarthroplasty for fracture with glenoid deficiency - a CAD/CAM implant

Revision arthroplasty with a hip-inspired computer-assisted design/computer-assisted manufacturing implant for glenoid-deficient shoulders

These authors report 21 patients with failed post-traumatic humeral head replacement performed for the treatment of proximal humeral fracture or fracture sequelae associated with rotator cuff and glenoid deficiency who underwent revision with CAD/CAM shoulder replacement (Stanmore Implants, Elstree, UK).

Active shoulder range of motion was not changed significantly by the revision. Postoperative complications occurred in 9 patients (43%) and included 1 infection, 2 periprosthetic fractures, 2 prosthetic dislocations, and 4 fixation screw fractures. 

The concept used in the CAD/CAM shoulder is similar to previous Stanmore designs (see below).

There is no question that revision of an unstable, rotator cuff and bone deficient failed arthroplasty can provide a huge surgical challenge and each case presents a highly unique situation and calls for examination of all possible options (including non-operative management, CTA arthroplasty and reverse total shoulder). In looking over one of the example cases (below), 

one might wonder if a CTA prosthesis might have provided a more cost-effective and potentially safer approach to reconstruction. 

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