Arthroscopic Removal of the Glenoid Component for Failed Total Shoulder Arthroplasty

Abstract

W hile total shoulder arthroplasty has a successful clinical track record for pain relief and improvement of function, there are substantial concerns regarding the prevalence of glenoid lucent lines and therefore the possibility of loosening of the glenoid component over the long term1,2. Options for treatment of symptomatic glenoid loosening include revision of the component or conversion to a hemiarthroplasty by removal of the loose glenoid component with or without bone-grafting of the glenoid3. The philosophy behind glenoid component removal is based on reports of humeral hemiarthroplasty that have shown that it is indeed possible to have satisfactory pain relief without a glenoid component4-12. The purpose of this report is to present an arthroscopic method for removing a symptomatic loose glenoid component and the underlying cement mantle. This study was approved by our institutional review board, and all patients had, on file, a signed consent form indicating their willingness to have their data used in a research publication. B etween June 1995 and May 2000, five patients, sixty-seven to seventy-eight years of age, required surgical intervention to treat a painful failed total shoulder prosthesis with isolated loosening of the glenoid component. Each patient had a relative contraindication against either reimplantation of a glenoid component or the performance of a major operation (Table I). All five patients had received the primary total shoulder arthroplasty at our institution. The right (dominant) shoulder was affected in three patients, and the left (nondominant) shoulder was affected in two. The shoulder arthroplasty had initially been performed to treat primary osteoarthritis in four patients and osteoarthritis secondary to synovial osteochondromatosis in one. View this table: TABLE 1 Data on the Patients The glenoid components were all standard (large) ultra-high molecular weight polyethylene Cofield components (Richards, Memphis, Tennessee) that had been inserted …