A 50 year old active woman presented with right shoulder pain and stiffness along with a sense of instability on elevating the arm. Her Simple Shoulder Test was 5 out of 12. Her x-rays showed degenerative joint disease
with posterior decentering into a posterior glenoid concavity when the arm was elevated into a functional position.
She elected a total shoulder arthroplasty using a standard glenoid component inserted without specific attempt to change glenoid version along with an anteriorly eccentric humeral head component to manage the tendency for posterior decentering noted preoperatively and at surgery.
In spite of her excellent rehab effort, the shoulder was stiff at two months after surgery; at that point she had a manipulation under anesthesia.
Now, at two years after surgery, her SST score has improved from 5 preoperatively to 11 out of 12 at two years. As measured by the Kinect, her active flexion had improved from 123 to 177 degrees.
Her x-rays at two years are shown below. The AP shows bone ingrowth into the flanges of the glenoid component and the impaction-grafted thin humeral stem.
The axillary view shows the eccentric humeral head centered on the standard glenoid component.
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Interestingly, the posterior decentering was less evident on the CT scan she had obtained previously.
In spite of her excellent rehab effort, the shoulder was stiff at two months after surgery; at that point she had a manipulation under anesthesia.
Now, at two years after surgery, her SST score has improved from 5 preoperatively to 11 out of 12 at two years. As measured by the Kinect, her active flexion had improved from 123 to 177 degrees.
Her x-rays at two years are shown below. The AP shows bone ingrowth into the flanges of the glenoid component and the impaction-grafted thin humeral stem.
The axillary view shows the eccentric humeral head centered on the standard glenoid component.
Her active motion is shown below.
This case demonstrates a conservative, bone preserving approach to this type of glenohumeral pathoanatomy.
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