Revisions for aseptic glenoid component loosening after anatomic shoulder arthroplasty

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• 作者：William R. Aibinder ; MD^a ; Bradley Schoch ; MD^b ; Cathy Schleck ; BS^a ; John W. Sperling ; MD ; MBA^a ; ^{sperling.john@mayo.edu} ; Robert H. Cofield ; MD^a
• 关键词：Level III ; Retrospective Cohort Design ; Treatment Study
• 刊名：Journal of Shoulder and Elbow Surgery
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：26
• 期：3
• 页码：443-449
• 全文大小：836 K
• 卷排序：26

文摘

Glenoid component loosening is a common indication for revision shoulder arthroplasty. The objective of this study is to assess the longer-term outcomes of patients undergoing revision specifically for aseptic loosening.Materials and methodsBetween 1985 and 2005, 34 revision shoulder arthroplasties were performed for aseptic glenoid loosening. Three patients were lost to follow-up. Treatment included component reimplantation in 20 shoulders (group I) or component removal with bone grafting in 11 shoulders (group II). We identified 9 cases of instability with or without rotator cuff tearing prior to revision. The mean follow-up period was 8.3 years.ResultsThe rate of survival free of reoperation at 10 years was 78.9% in group I and 83.9% in group II (P = .5). Pain relief occurred in 26 of 31 shoulders, with no difference between groups (P > .99). Active elevation and external rotation improved in both groups (P = .8). Five shoulders in group I had radiographically loose glenoids, with two requiring reoperation. Nine shoulders in group II had medial glenoid erosion, with two requiring reoperation for pain. There was a trend toward reoperation in those with preoperative instability (5 of 8 re-revisions).Discussion and conclusionGlenoid revision surgery in the absence of infection provides satisfactory results, especially when instability is not coexisting. When glenoid bone stock permits, reimplantation of a new glenoid component in an active patient with an intact rotator cuff and no instability is reasonable. When the remaining glenoid bone will not support a new component, conversion to a hemiarthroplasty is also reasonable.