Wednesday, March 29, 2017

Posterior glenoid bone loss and total shoulder arthroplasty

Two years ago a middle age patient presented with pain, stiffness and a sensation of posterior instability of the right shoulder. There was no history of seizures or prior injury to either shoulder. The exam showed stiffness, pain and posterior translation as the arm was elevated. X-rays showed posterior superior displacement of the humeral head on an eroded glenoid.

The patient wished to avoid a reverse total shoulder arthroplasty and asked to have an anatomic total shoulder. Two years after a total shoulder with a standard glenoid component,  the patient has a comfortable, stable and functional shoulder. Current x-rays show centering of the humeral head in the prosthetic glenoid without evidence of instabilty or loosening.

Interestingly the left shoulder is becoming similarly symptomatic and has the radiographic appearance shown below.

The patient desires a similar procedure on the left.

Comment: This pathology is unusual in our experience. For this active patient, we elected the most bone-conserving method of reconstruction. Should this fail down the line, there would be sufficient bone stock for a reverse total shoulder.

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