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 Management of failed metal-backed glenoid component in patients with bilateral total shoulder arthroplasty

Xinning Li1, Josef K Eichinger2, Laurence D Higgins3
1 Assistant Professor, Sports Medicine and Shoulder and Elbow Surgery, Department of Orthopaedics, Boston University School of Medicine, 720 Harrison Avenue - Suite #808, Boston, MA 02118, USA
2 Assistant Professor of Surgery, Chief of Shoulder & Elbow Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
3 Assistant Professor, Chief of the Sports Medicine and Shoulder Service. Harvard Medical School. Brigham and Women's Hospital, Boston, MA, USA

Correspondence Address:
Xinning Li
Assistant Professor, Sports Medicine and Shoulder and Elbow Surgery, Department of Orthopaedics, Boston University School of Medicine, 720 Harrison Avenue - Suite #808, Boston, MA 02118
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6042.123527

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Year : 2013  |  Volume : 7  |  Issue : 4  |  Page : 143-148

 
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Total shoulder arthroplasty (TSA) is successful in providing pain relief and functional improvements for patients with shoulder arthritis. Outcomes are directly correlated with implant position and fixation, which ultimately affects wear and longevity. Metal-backed glenoid components were introduced as an alternative to the standard cemented glenoid fixation. Early loosening and cavitary glenoid bone loss has been reported as a major complication associated with these metal-backed glenoids, which presents the surgeon with a challenging revision situation. Furthermore, failure of bilateral TSA in patients with metal-backed glenoids is extremely rare. We present two patients with early failure of bilateral TSA secondary to loosening of the metal-backed glenoids. Both patients had significant glenoid bone loss and were treated with four different types of revision techniques. A description of treatments and outcomes of both patients are reported along with the simple shoulder test and American Shoulder and Elbow Surgeons scores. One patient underwent revision to bilateral reverse prosthesis and experienced a much-improved outcome in comparison to the patient revised to a hemiarthroplasty and resection arthroplasty, for each shoulder respectively. In patients who present with failed TSA, revision to a reverse prosthesis with or without staged glenoid bone graft should be considered as an option of treatment. It is also important to rule out infection with intraoperative tissue biopsy before proceeding to revision surgery. However, in patients with catastrophic glenoid bone loss, both hemiarthroplasty and resection arthroplasty can provide an alternative treatment option, but they are associated with a poorer functional outcome and pain relief.






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© 2006 - International Journal of Shoulder Surgery
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Xinning Li1, Josef K Eichinger2, Laurence D Higgins3
1 Assistant Professor, Sports Medicine and Shoulder and Elbow Surgery, Department of Orthopaedics, Boston University School of Medicine, 720 Harrison Avenue - Suite #808, Boston, MA 02118, USA
2 Assistant Professor of Surgery, Chief of Shoulder & Elbow Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
3 Assistant Professor, Chief of the Sports Medicine and Shoulder Service. Harvard Medical School. Brigham and Women's Hospital, Boston, MA, USA

Correspondence Address:
Xinning Li
Assistant Professor, Sports Medicine and Shoulder and Elbow Surgery, Department of Orthopaedics, Boston University School of Medicine, 720 Harrison Avenue - Suite #808, Boston, MA 02118
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6042.123527

Get Permissions

Total shoulder arthroplasty (TSA) is successful in providing pain relief and functional improvements for patients with shoulder arthritis. Outcomes are directly correlated with implant position and fixation, which ultimately affects wear and longevity. Metal-backed glenoid components were introduced as an alternative to the standard cemented glenoid fixation. Early loosening and cavitary glenoid bone loss has been reported as a major complication associated with these metal-backed glenoids, which presents the surgeon with a challenging revision situation. Furthermore, failure of bilateral TSA in patients with metal-backed glenoids is extremely rare. We present two patients with early failure of bilateral TSA secondary to loosening of the metal-backed glenoids. Both patients had significant glenoid bone loss and were treated with four different types of revision techniques. A description of treatments and outcomes of both patients are reported along with the simple shoulder test and American Shoulder and Elbow Surgeons scores. One patient underwent revision to bilateral reverse prosthesis and experienced a much-improved outcome in comparison to the patient revised to a hemiarthroplasty and resection arthroplasty, for each shoulder respectively. In patients who present with failed TSA, revision to a reverse prosthesis with or without staged glenoid bone graft should be considered as an option of treatment. It is also important to rule out infection with intraoperative tissue biopsy before proceeding to revision surgery. However, in patients with catastrophic glenoid bone loss, both hemiarthroplasty and resection arthroplasty can provide an alternative treatment option, but they are associated with a poorer functional outcome and pain relief.






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© 2006 - International Journal of Shoulder Surgery
| Published by Wolters Kluwer - Medknow Online since 1st September '06