Tuesday, November 5, 2013

Revision for loose glenoid - repost

Here is an x-ray of a very active man in his 70's who had a shoulder arthroplasty performed elsewhere 8 years prior. It had performed well for about five years and then became painful and week. His Simple Shoulder Test scored 2 when we saw him in consultation. Note the complete deterioration of his polyethylene glenoid as indicated by loss of the normal lucent space between the metal humeral head and the glenoid bone. Note also the displacement of the metal markers in his glenoid component and the glenoid cysts.
At the time of his surgery, we confirmed the glenoid component destruction and harvested multiple specimens for culture. After removal of all components and careful debridement, a new humeral prosthesis was inserted with Vancomycin allograft. His motion and IV antibiotics were started immediately after surgery. His cultures grew out Propionibacterium and Coag Negative Staph.

On his clinic visit today he reported that he was back to fishing, fly tying, and wants to get after the logs in his back yard with his chain saw. His SST is now 7. His x-rays show filling in of the glenoid defect and secure fixation of his humeral stem. He will remain on oral antibiotics for the remainder of the year.

This represents our standard approach to what may initially appear to be 'aseptic loosening'.

We apparently confused one reader who wrote: "Interesting article, but I'm a bit confused on the revision. The Glenoid and Humeral component were both removed and you replaced the Humeral component with Vancomycin allograft. Was this allograft to the glenoid side or did you replace the glenoid component also? Can you revise a loosed glenoid component by complete removal and then using the Ream and Run procedure? Great Blog as always!"

The allograft was only used to secure the humeral component (note the revision stem was narrower in diameter than the original). As our posts on revision arthroplasty demonstrate, we do not graft the glenoid after removal of the loose glenoid component. We simply smooth the residual bony surface without formal reaming so that we preserve as much glenoid bone stock as possible.

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