Wednesday, October 25, 2017

The problem with suture anchors: anchor arthropathy

Suture anchors are in common use, but when they are prominent on the glenoid surface they produce arthritis - what we call anchor arthropathy.
Yesterday we encountered another such case - anchor arthropathy in a 39 year old man who presented with pain, stiffness and a Simple Shoulder Test score of 1 out of 12.

His preoperative films are shown here

While he elected a total shoulder arthroplasty with the glenoid component placed on top of the suture anchors rather than a ream and run, which would have required removal of the suture anchors and substantial sacrificed of glenoid bone stock.
His suture anchors were prominent at surgery as shown by this intraoperative photograph.
It was easy to see how these anchors excoriated his humeral articular cartilage.
We used a pine cone bur to recess the anchors below the bone surface to enable reaming. To avoid conflict with the anchors, an all polyethylene glenoid component was inserted upside down with the two pegs superiorly (rather than the usual two peg inferior configuration).
Postoperative films are shown here. The arrows point to the metal marker in the ingrowth central peg.

The morning after surgery (performed without a plexus block) he had 150 degrees of assisted flexion with minimal oral analgesics and was ready for discharge.

Comment: This is not an uncommon reason for shoulder arthroplasty in our referral practice. Other examples are shown in these links: linklink and link.
Surgeons using glenoid suture anchors need to be sure they are placed so that they are not and will not become in contact with the humeral head. Otherwise it should be

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