Monday, January 8, 2018

Revision of a loose TM total shoulder

We had the opportunity to see a 59 year old woman with a complex surgical history of 5 or 6 operations, initially starting with a labral repair in the early 2000's. She had a total shoulder done in 2010, which was revised for stiffness and pain in 2013. In July 2017 she presented to us for the first time, reporting progressive decline in function and an increase amount of pain. She noted significant chronic swelling in her upper arm. She had nocturnal pain and pain with activity.

Her  presenting x-rays are shown below suggesting loose TM humeral and glenoid components with glenoid malposition and humeral subsidence.

Our surgical revision included removal of the loose components, smoothing without grafting of her residual glenoid and impaction allografting of a humeral component. Intraoperative cultures were obtained and she was kept on oral antibiotics for 3 weeks at which time the cultures were finalized as negative.

At her six week post op visit she reported that her shoulder was more comfortable than it had been in years. She demonstrated excellent assisted motion and was started on strengthening exercises.

Her postoperative films show restoration of the humeral component at the proper height and excellent seating of the humeral prosthesis in the bony glenoid,

While her long term outcome is still forthcoming, this case does demonstrate the conservative approach to revision of a failed total shoulder that we have found to be safe and effective.