Return to swimming by a woman after single stage revision for Cutibacterium PJI

Here are the x-rays of an active woman in her 60s with degenerative arthritis and a Simple Shoulder Test of 5/12.

After a discussion of the options and in consideration of her active lifestyle, she elected to proceed with a ream and run procedure in order to avoid the potential risks and limitations of a prosthetic glenoid component.

At her six weeks check her shoulder was a bit stiff in spite of her great rehabilitative effort; she elected to have a manipulation under anesthesia and complete muscle relaxation - a full range of passive motion was achieved.

Four months after the ream and run, she returned with a much improved shoulder and these x-rays

Note the impaction grafted stem and the conservatively reamed glenoid, now with a radiographic joint space between it and the prosthetic humeral component.

Five months after her surgery she was swimming at Coogee beach, the site of the famous "shark arm case (see this link)".

 and kindly gave us permission to show her swimming form here.

Three years after her ream and run she developed a painful, stiff shoulder without an obvious cause.

Because of our high suspicion for a periprosthetic infection we elected to explore her shoulder. The joint fluid was cloudy and a synovial biopsy showed papillary hyperplasia, fibrosis, and mixed acute and chronic inflammation with focally greater than 20 neutrophils per high power field. The humeral component was mildly loose and surrounded by a membrane. A single stage exchange with thorough debridement was followed by a course of intravenous antibiotics. Two weeks after surgery her intraoperative cultures were positive for Cutibacterium.

Three months after the single stage exchange she was back swimming. 

Fifteen years after her single stage revision she reports "I hope you are well too! It’s been great.  Swimming and pilates seem both to be very very good for the shoulder.  Got good strength and range of motion.  Thanks again."

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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 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).

Technique vs technology: managing a B2 glenoid in an active 67 year old woman. 9 year followup

It is said that "technology is something we buy and technique is something we learn".

In that light, let's consider an active woman in her mid sixties from Alaska presented with activity limiting shoulder pain and stiffness as reflected by her Simple Shoulder Test

Her radiographs at the time of presentation are shown below. Her axillary "truth" view shows posterior decentering of the arthritic humeral head on a posteriorly eroded glenoid with a degenerative cyst.

After discussion of non-operative management, anatomic total shoulder, reverse total shoulder and the ream and run procedure, she elected the latter.

No preoperative CT scan, MRI, or 3D planning was carried out. The procedure was performed under general anesthesia without a nerve block; no patient specific instrumentation was used; the biceps tendon was preserved; the glenoid labrum was preserved; the glenoid was conservatively reamed - just enough to create a single concavity; no glenoid component was used; the smooth (non-ingrowth) standard length humeral component was fixed with impaction autografting; and an anteriorly eccentric humeral head component was used to provide posterior stability.

Followup radiographs showed that her humeral component was stable without evidence of stress shielding and that her anteriorly eccentric humeral head was centered in the glenoid on the axillary "truth" view.

At nine years after her ream and run at the age of 76 she reported the ability to perform all 12 of the Simple Shoulder Test Functions and added that she recently spent 30 days canoeing many miles down then Chandalar and Yukon Rivers in Alaska, going 35 miles the last day. While the photos below are not from her trip, they show a bit about these two rivers.

You can support cutting edge shoulder research that is leading to better care for patients with shoulder problems, click on this link

Follow on twitter/X: https://x.com/RickMatsen
Follow on facebook: https://www.facebook.com/shoulder.arthritis
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).