Wednesday, March 29, 2017

A case of glenoid component failure with a simple revision

A patient present to us recently with progressive pain and feelings of instability starting 13 years after a left total shoulder arthroplasty. On examination the shoulder was painful and clunking on any movement. Radiographs shown below demonstrate glenoid loosening as well as glenoid and humeral osteolysis.

At revision 44 21 humeral head was removed. The posterior aspect of the glenoid component was seen to be worn through. Joint fluid was clear and frozen section showed foreign body reaction and particulate debris without findings of acute inflammation. The glenoid bone was severely deficient.

After thorough removal of the reactive tissue from the humerus and glenoid bone, a 52 18 humeral head was inserted on the retained humeral stem and seen to be stable in the eroded glenoid cavity.

On the morning after surgery the patient had assisted elevation of 150 degrees without clunking or sensation of instabilty. 

Comment: While the eventual clinical outcome remains to be determined, we were pleasantly surprised that a stable shoulder could be achieved with this simple conversion, especially since we were prepared to perform a reverse total shoulder had this approach not been successful.

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