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Glenoid component failure after total shoulder arthroplasty

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Glenoid component failure remains a most important cause of failure after total shoulder arthroplasty (see Glenoid component failure in total shoulder arthroplasty).  Glenoid component failure may be related to 

(1) poor surgical technique, such as inadequate seating of the component (see The radiographic evaluation of keeled and pegged glenoid component insertion), the use of back-side cement to compensate for inadequate glenoid bone preparation 

or poor cement technique

(2) inferior polyethylene leading to wear and particulate debris (see this link), 


(3) metal backed components (see Metal-Backed Glenoid Components Have a Higher Rate of Failure and Fail by Different Modes in Comparison with All-Polyethylene Components: A Systematic Review

(4) poor humeral component placement



(5) instability or cuff failure giving rise to rocking horse loosening from eccentric loading of the glenoid component (see Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency)


and (6) infection (see Loose glenoid components in revision shoulder arthroplasty: is there an association with positive cultures?)

Glenoid component failure may become clinically evident years after the index procedure as in this case that came to revision 24 years after the index procedure.



 

An interesting question is “how should we monitor our patients for the possibility of glenoid component loosening?” which, as the example above shows, may become manifest years or decades after the arthroplasty.  Obviously having patients come back annually or periodically for x-rays is impractical for them and for us. Since clinical failure is more relevant than radiographic lucent lines, one approach is to send short questionnaires such as the Simple Shoulder Test annually to each patient and to be on the watch for deterioration in comfort and function as discussed here, Patient Functional Self-assessment in Late Glenoid Component Failure at three to eleven years after Total Shoulder Arthroplasty.

The surgical management of a loose glenoid component requires a thorough evaluation of the shoulder pathoanatomy, shoulder function, possibility of infection, and wishes of the patient.

Total Shoulder Arthroplasty: Can it Work?

However, this approach does not allow for revision of the humeral head component to compensate for the loss of the glenoid component, which can be accomplished at open revision as shown below.

Finally, consideration can be given to conversion to a reverse total shoulder recognizing the technical difficulty and complication rate as described here, 

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

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