Failed hemiarthroplasty revised to reverse

Here's an interesting case from our operating room yesterday.

A patient had this prosthesis inserted elsewhere for arthritis.

From these plain films one can see that the line of humeral head resection was high, the prosthetic stem was placed high and the eccentricity of the humeral head was turned upwards. As a result of these three factors, the humeral head had worn through the rotator uff and into the acromion. She had painful pseudo paralysis

The porous coat on the prosthesis made for a difficult stem removal. The conversion to a reverse total shoulder was made additionally difficult by the superior glenoid erosion. The weakened humeral bone was reinforced by a fine wire mesh inserted into the medullary canal.

Here is her post op film

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