Wednesday, April 30, 2014

Revision for failed total shoulder with overstuffing

After a total shoulder arthroplasty performed elsewhere the shoulder imaged below was stiff and painful. It had not responded to therapy and a revision soft tissue surgery. On examination there was painful stiffness with only 30 degrees of glenohumeral motion in elevation and in rotation. Note the high position of the prosthesis in the humerus, the residual neck, and the resulting lateralization of the tuberosity - we refer to this as 'overstuffing'.

The original implant system did not offer a narrower head, so, at the time of revision surgery we removed the original head and stem, resected the excess humeral neck, retained the glenoid, performed a 360 degree periglenoid soft tissue release, and implanted a narrower head and body from a different implant system, fixing the stem with impaction allograft.

Note the improved relationship of the humeral head component and the greater tuberosity as well as the narrowing of the distance between the tuberosity and glenoid.

At the time of discharge on the second post operative day the shoulder had 160 degrees of comfortable assisted elevation.

Comment: In this case it was necessary to mix components from two different systems. The simpler body neck junction and the narrower head of the second system as well as additional resection of the retained humeral neck enabled the improvement of the head positioning.


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