Saturday, February 25, 2017

Failed shoulder arthroplasty

Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants

Revisions of failed shoulder arthroplasties are on the rise.  From 2010 to 2012 60 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty by an individual surgeon.

Forty-four of these patients were available for follow-up after a mean of 24 months. Seven (16%) of these revisions had complications:

Comment: We found the two case examples particularly interesting, not because of the revisions, but because of the implants requiring revision.

Here is an unstable total shoulder arthroplasty in which a metal backed, cementless glenoid component had become loose. The ingrowth humeral stem required extensive osteotomy for removal.

And here is a stemless humeral component complicated by a proximal humeral fracture.

 In reading papers on revisions, it is always worthwhile to ask whether revisions might have been (a) less likely and (b) less complex with more conventional implants, such as an all-polyethylene ingrowth glenoid component

and a non-ingrowth humeral stem

inserted with impaction autografting.