Arthroscopic glenoid removal for symptomatic component loosening in anatomic total shoulder arthroplasty: can it work?

Abstract

BackgroundGlenoid loosening is a common cause of failure in anatomic total shoulder arthroplasty (aTSA). Arthroscopic evaluation and removal of the loose glenoid component is a treatment option, but data on this technique is limited. The purpose of this study was to evaluate the outcomes following arthroscopic glenoid removal for aTSA patients with symptomatic glenoid loosening. MethodsA retrospective case series was performed to identify aTSA patients with symptomatic glenoid component loosening, who underwent arthroscopic evaluation and glenoid removal from 2005-2019. Date of index shoulder arthroplasty, culture results, and any subsequent revision shoulder procedures were documented. All patients were contacted via telephone to obtain American Shoulder and Elbow Surgeons, Simple Assessment Numeric Evaluation, satisfaction scores (0-100), reoperation performed at an outside facility, and whether they would undergo the operation again. ResultsTwenty-three patients were identified who underwent arthroscopic glenoid removal, of which 20 (87%) were available for a follow-up. Patients had a mean age of 65.6 ± 11.9 years, body mass index of 29.4 ± 6.2 kg/m2, and 12/20 were females (60%). The average time from index aTSA to arthroscopic glenoid removal was 7.0 ± 3.6 years (range, 1.9-11.9 years). All patients had loose glenoids at the time of arthroscopic evaluation and 5 patients (25%) had concurrent rotator cuff tears. All patients had cultures obtained at the time of arthroscopy and none were positive. Five patients (25%) underwent revision to reverse total shoulder arthroplasty at a mean 7.4 ± 4.2 months, for a survival of 75% at final follow-up. Comparing patients who underwent revision to those who did not, there was no difference in age (61.0 ± 9.2 vs. 67.1 ± 12.6 years, P = .34), body mass index (29.8 ± 9.5 vs. 29.2 ± 5.1 kg/m2, P = .86), sex (100% vs. 47% female, P = .06), time from index aTSA to glenoid removal (63.0 ± 38.4 vs. 91.4 ± 43.9 months, P = .34), or presence of rotator cuff tear (20% vs. 27%, P = 1.0). Of the 15 patients (75%) who did not undergo reoperation, the average American Shoulder and Elbow Surgeons, Simple Assessment Numeric Evaluation, and Satisfaction scores were 54.3 ± 29.2, 53.5 ± 27.6, and 65.9 ± 37.9 respectively, at an average follow-up of 36.0 ± 19.5 months (range, 12-67 months). No patient (0%) who underwent reoperation would undergo the arthroscopic glenoid removal again, whereas 12 patients (60%) who did not undergo reoperation would choose to have an arthroscopic glenoid removal again. ConclusionsGlenoid loosening is an unfortunate complication of aTSA. Survival was 75% for patients who underwent arthroscopic glenoid removal with modest patient reported outcomes. In appropriately selected patients, arthroscopic glenoid removal is a reasonable treatment option to consider for symptomatic glenoid component loosening.