Failed glenoid components - bad and good news.

We recently had the opportunity to revise two total shoulders for failed glenoid components. That's the bad news. The good news is that the glenoid components had been in place for a long time.

The first case had a total shoulder in 1995 with a great functional result. Eleven years later it started to become somewhat less comfortable; the x-ray appearance at that time is shown below.

22 years after the total shoulder pain had increased to the point that the patient desired a revision; the x-ray appearance at that time is shown below: glenoid component loosening and osteolysis.

At revision surgery the glenoid component was loose and showed concentric wear.

There was a large osteolytic defect in the glenoid bone and no possibility of component reinsertion. After thorough curettage of the defect, a large diameter humeral head prosthesis was inserted to sit on top of the defect.

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In the second case a total shoulder had been performed in 2004,

In 2008 the shoulder was functioning well; the x-ray appearance at that time is shown below.

In 2017 the shoulder had become painful; the x-ray appearance at that time is shown below: glenoid component failure with major osteolysis of the glenoid and humerus

At revision surgery the glenoid component was loose and showed severe wear.

 There was a large chronic inflammatory mass attached to the back of the component that had eroded into the glenoid bone.

There was a large osteolytic defect in the glenoid bone and no possibility of component reinsertion. After thorough curettage of the defect, a large diameter humeral head prosthesis was inserted to sit on top of the defect.

In both cases early assisted range of motion was started on postop day 1.

Comment: This may represent examples of the best case scenario for prosthetic glenoids. In both cases the patient had enjoyed a long time of shoulder comfort and function. But in both cases the failed glenoid components left large cavitary defects. 

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