Surgical treatment of nonconstrained glenoid component failure

Abstract

Total shoulder replacement for pathological conditions of the glenohumeral joint has proven to be a very durable procedure with a low complication rate and a high rate of patient satisfaction. Glenoid component revision rates reported in the literature are generally less than 4% (range, 0 to 12.5%) for nonconstrained total shoulder replacements at 3- to 5-year follow-up. Glenoid component failure occurs as a result of loosening, breakage, or damage of the glenoid component. The causes for glenoid component failure include infection, trauma, eccentric loading after a rotator cuff tear, and technical errors. Technical factors include inadequate glenoid bone contouring allowing rocking of the platform, excessive cement buildup with noncontained cement that may break free and allow toggling of the platform, and component malalignment or poor soft tissue balancing leading to dislocations with associated loosening or breakage. The patients experience pain and loss of motion, and diagnostic radiographs often reveal a progressive increase in radiolucencies around the glenoid component. Treatment consists of glenoid component replacement when bone stock allows or glenoid component removal with upsizing of the humeral head when bone stock is insufficient to support a new component. In the case of infection, removal of both components is advocated. Results of glenoid component revision surgery are satsifactory in the majority of cases, with patients who have intact and normally functioning deltoid and rotator cuff muscles faring better than those who have some form of compromise.