Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty?
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SUBMITTER: Service BC
PROVIDER: S-EPMC5638733 | biostudies-literature | 2017 Nov
REPOSITORIES: biostudies-literature
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Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty?
Service Benjamin C BC Hsu Jason E JE Somerson Jeremy S JS Russ Stacy M SM Matsen Frederick A FA
Clinical orthopaedics and related research 20170705 11
<h4>Background</h4>While glenoid retroversion and posterior humeral head decentering are common preoperative features of severely arthritic glenohumeral joints, the relationship of postoperative glenoid component retroversion to the clinical results of total shoulder arthroplasty (TSA) is unclear. Studies have indicated concern for inferior outcomes when glenoid components are inserted in 15° or more retroversion.<h4>Questions/purposes</h4>In a population of patients undergoing TSA in whom no sp ...[more]
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Project description:We present a technique for arthroscopic glenoid removal in a case of glenoid loosening after total shoulder arthroplasty (TSA). The presented technique is technically feasible and may be useful if 1-stage surgery with glenoid reimplantation is not indicated. To exclude low-grade infection, the presented technique allows for an intraoperative infection workup such as intraoperative cultures. However, glenoid loosening in TSA is a well-known problem and has been described before. The advantages of the presented technique include minimally invasive surgery, decreased pain, preservation of the subscapularis tendon, and assurance of exclusion of low-grade infection before reimplantation of a new glenoid implant. In this case a 73-year-old patient was treated with a TSA for severe osteoarthritis of the right shoulder in April 2014. Because of persistent anterior shoulder pain postoperatively, radiographic evaluation was performed and showed signs of glenoid loosening 6 months after surgery without any clinical signs of infection. To exclude low-grade infection, arthroscopy of the right shoulder was performed. Arthroscopy showed a totally loosened glenoid component leading to arthroscopic glenoid removal by use of a special forceps.
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Project description:BackgroundHybrid glenoid components in total shoulder arthroplasty (TSA) utilize both polyethylene and metal components to provide short-term stability and long-term biologic fixation through bone ingrowth.Questions/purposeWe sought to systematically review the literature for studies that assessed outcomes of TSA performed using hybrid glenoid components.MethodsPubMed, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched systematically for articles measuring clinical and patient-reported outcomes and rates of complication and revision following TSA using a hybrid glenoid component.ResultsSeven studies with 593 shoulders were included in this review. The mean age of patients was 65 ± 1 years, and 46% of the population was male. Mean follow-up was 50 months (4.2 years). The overall complication rate was 7% and rate of revision was 2.5%; glenoid radiolucency was present in 33% of shoulders at mean follow-up of 50 months. Mean improvements in forward elevation, external rotation, internal rotation score, and abduction were 49°, 28°, 2 points, and 42°, respectively. Mean improvements in Constant, American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores were 36 points, 52 points, and 17 points, respectively.ConclusionOur review found that TSA using hybrid glenoid components results in low rates of complication and revision at early follow-up. Long-term studies are warranted to understand more fully the role of hybrid glenoid components in TSA.
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Project description:Aseptic glenoid component loosening after anatomic total shoulder arthroplasty remains an important cause of late clinical failure and revision surgery. We present here the surgical technique of all-arthroscopic removal and glenoid bone grafting. Arthroscopic removal of a loose glenoid component and bone grafting of the glenoid defect without dermal allograft preserves glenoid bone stock and obviates the need for multiple suture anchors to hold the graft in place.
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