Monday, May 8, 2017

Glenoid dysplasia - less is more

A 40 year old patient presented with pain, stiffness and clunking after prior posterior labral repair for glenoid dysplasia.

His x-rays on presentation are shown here.

Six weeks ago he had a left shoulder hemiarthroplasty, at which time there was a total loss of articular cartilage over the humeral head and partial loss over the glenoid. There was a large posterior limbus. In spite of a detailed search over and under the limbus, the suture anchors were not visable or palpable.

The humerus was prepared to receive the definitive humeral component, which was the 56 18 12. A rotator interval plication was not required to provide posterior stability. A stable articulation was achieved.

Now, 6 weeks after surgery he has improved comfort and active elevation to 120 degrees. His x-rays are shown below.

Comment: This approach seemed appropriately conservative for a young active person in comparison to posterior bone grafting, a posteriorly augmented glenoid component or a reverse total shoulder. It is also conservative in that the amount of bone removal was minimal, leaving all other reconstructive options available in the future.

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