Wednesday, August 10, 2011

Revision surgery for failed shoulder replacement arthroplasty due to glenoid component failure, Part 10

To continue with our discussion of the management of glenoid component failure, we've observed that attempts to reinsert a new glenoid component are accompanied by a high failure rate due to to the loss of supporting bone (two right hand figures below) in contrast to the situation when the first glenoid component was inserted (two left hand figures below).
Thus when we encounter a substantial glenoid defect, such as that shown below
rather than using a large amount of cement, bone graft, or a special component to fill the defect, we have been pleased with the result from removing all polyethylene, bone cement, and rough bone and then contouring the residual glenoid bone to support a new humeral head component (usually one with a diameter of 56 mm to achieve the maximal contact area). This essentially converts the failed total shoulder to a ream and run. We do not fill the defect with bone graft, finding that the defect fills in itself with time.


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