Optimizing the technique of glenoid arthroplasty may further reduce the rate of glenoid component loosening (see The glenoid component in total shoulder arthroplasty: getting it done right).
When glenoid loosening does occur, What is the Optimal Management of a Loose Glenoid Component after Anatomic Total Shoulder Arthroplasty.? These authors conducted a systematic review of the available literature to determine the published outcomes for different management strategies addressing symptomatic glenoid loosening.
14 studies met their inclusion criteria with 483 patients having a mean age of 67. The times of followup and the rates of re-operation for four different surgical approaches are shown below. Note that these re-revision rates are ten times higher than the glenoid revision rate for primary total shoulder arthroplasty.
Glenoid bone grafting during revision arthroplasty was performed in 335 of the 483 patients (69%).
The humeral component was explanted in 291 instances (64%); 161 out of 164 (98%) patients having conversion to an RSA required removal of the humeral component. Six studies reported at least 1 intraoperative complication, with the most common complication being humeral fracture (shaft or greater tuberosity) during stem removal (40 of the 44 total intraoperative complications reported).
The most common repeat surgery following conversion to hemiarthroplasty was conversion back to a total shoulder arthroplasty with glenoid reimplantation.
The most common repeat surgery following conversion to 1-stage TSA was conversion to a reverse shoulder arthroplasty.
The most common repeat surgery following conversion to RSA was conversion to a hemiarthroplasty, typically because of baseplate failure.
Among the 14 studies included in this systematic review, only 4 studies mention obtaining cultures during revision arthroplasty. Positive cultures were noted in 15% of the patients; Cutibacterium accounted for 72% of the positive cultures.
Comment: The management of a patient with a loose anatomic glenoid needs to be tailored to the characteristics of the patient and the shoulder.
Some patients with a loose glenoid component are insufficiently symptomatic to justify a revision surgery, especially in light of the one in five chances of a re-revision.
In others, a conservative stem-preserving procedure (avoiding the risk of humeral fracture) may be indicated consisting of glenoid component removal with exchange of the humeral head to a size and eccentricity that conforms to the residual glenoid bone as shown in the examples below.
One or two stage re-implantation of a glenoid component or revision to a reverse total shoulder can be considered in certain cases considering the associated risks and benefits.
Hopefully the need for revision for glenoid component loosing will continue to decrease with attention to the details of component selection, positioning and fixation (see this link)
You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link.
To add this blog to your reading list in Google Chrome, click on the reading list icon
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
To add this blog to your reading list in Google Chrome, click on the reading list icon
Follow on twitter: https://twitter.com/shoulderarth
Follow on facebook: click on this link
Follow on facebook: https://www.facebook.com/frederick.matsen
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
