Wednesday, September 3, 2014

Failed resurfacing revised to an impaction grafted hemiarthroplasty.

A gentleman in his sixties presented to us  7 months status post a left shoulder resurfacing with a hemicap. He states that he has continued to have moderate to severe pain and stiffness in his shoulder that is worse than preop. He has been to 30-40 PT sessions without relief. He noted that his shoulder 'clicked' painfully on certain motion.
His x-rays at the time of his initial clinic visit are shown below. There is a suggestion of incomplete seating of the hemicap, lucency around the central peg, and varus positioning.

He desired revision arthroplasty. Specimens for culture were obtained before antibiotic administration. The resurfacing prosthesis was grossly loose and the bone beneath it very soft. A hemiarthroplasty was inserted using Vancomycin allograft. He is on the yellow protocol pending the results of culture.

Comment: While we do not use the resurfacing prosthesis in our practice, we have had the chance to revise a fair number of these procedures performed elsewhere. Those coming for revision have had problems of malposition, overstuffing, loosening, infection and stiffness.


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