Tuesday, May 8, 2018

Revising a loose short stem humeral component

One year after a total shoulder arthroplasty with a short stemmed prosthesis this patient developed progressively increasing shoulder pain.
Two years after the total shoulder the patient presented to us with shoulder pain at rest and on motion. X-rays on presentation are shown below, showing loosening of the humeral component.

The shoulder was revised in a single stage to an impaction allografted standard stemmed hemiarthroplasty out of concern for a possible infection.
Of note is the fact that no additional bone needed to be removed for the insertion of the standard stem (i.e. the short stem did not 'preserve' more bone than the standard stem). In fact the impaction allografting added bone to strengthen the humerus.

The patient was placed on antibiotics after surgery. These were discontinued when the cultures finalized at three weeks as negative.

Three months after surgery, the shoulder x-rays showed excellent consolidation of the allograft with the standard stem passing beyond the weakened area of the lateral cortex.

At three months, the shoulder was comfortable and had active motion as shown below.

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