Failed total shoulder revised to ream and run

 An active lady in her early 70's had a left total shoulder that became painful with use. She noted a "shifting" sensation when she elevated her arm. 

At the time of presentation, her examination revealed a stiff painful shoulder with a slipping sensation on shoulder flexion.

Her x-rays showed a humeral component placed high in relation to the tuberosity

a loose glenoid component

placed on a retroverted glenoid

Wishing to avoid a reverse total shoulder, the patient desired to have a revision with complete prosthesis exchange to a ream and run procedure.

At surgery the loose glenoid component was easily removed, the well fixed humeral component was removed, cultures were obtained, the glenoid was reamed to a smooth concavity without attempt to change the version and without grafting the defect.  

The immediate postoperative films are shown below.

The shoulder was started on immediate postoperative motion. Cultures were unremarkable at 3 weeks.

Seven years after her revision she presented because of arthritis in her right shoulder.

She states that her left shoulder is performing "normally". She demonstrated full active range of comfortable motion with no evidence of instability.

Her x-rays at 7 years after revision are shown below, demonstrating a regenerative soft tissue layer between the humeral head and the reamed glenoid.

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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 total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

Shoulder rehabilitation exercises (see this link).

Follow on twitter: Frederick Matsen (@shoulderarth)