Thursday, April 10, 2014

Reverse total shoulders - failures in soft bone

This week we saw two ladies with rheumatoid arthritis and osteopenia who had had reverse total shoulder arthroplasties using Grammont - style components.

In the first case the glenoid component had pulled away from the bone leaving a large bony defect and the metaphyseal part of the humeral stem had become partially unscrewed from the diaphyseal part of the stem and was loose in the proximal humeral bone which had been previously fractured.

The second case shows loosening of the glenoid component again with a massive glenoid bone defect. In addition the humerus has sustained two different fractures - the lower one healed and the upper one healing.

Comment: As surgeons push the indications for the reverse shoulder prosthesis, it needs to be recognized that a house is only as solid as the foundation on which it is built. Revision of these cases will be extremely difficult.


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