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.