REVISION TOTAL SHOULDER ARTHROPLASTY FOR THE TREATMENT OF GLENOID ARTHROSIS

The development of painful glenoid arthrosis is the most common reason for reoperation after replacement of the humeral head, We performed t wenty-two revision total shoulder arthroplasties, between 1983 and 199 2, for the treatment of painful glenoid arthrosis in shoulders that ha d a prosthetic replacement of the humeral head. Eighteen shoulders (se venteen patients) were included in the study as their preoperative and operative records were complete and they had been followed for at lea st two years (mean, 5.5 years; range, 2.3 to 10.0 years), The indicati ons for the hemiarthroplasty were trauma (ten shoulders). osteoarthros is (four), rheumatoid arthritis (two), and osteonecrosis secondary to the use of steroids (two). The mean interval between the hemiarthropla sty and the total shoulder replacement was 4.4 years (range, 0.8 to 12 .7 years). The mean score for pain in the shoulder decreased from 4.3 points before the revision to 2.2 points after if (p = 0.0001). The me an active abduction increased from 94 degrees before the revision to 1 24 degrees after it (p = 0.01), and the mean external rotation increas ed from 32 to 58 degrees (p = 0.007). Two shoulders needed another ope ration after the revision because of a late infection in one and parti culate synovitis associated with instability in the other, With the nu mbers available for study, we did not detect a significant difference in pain relief and range of motion with respect to gender, diagnosis, subluxation, off the presence of periprosthetic radiolucency. Our find ings indicate that most patients with painful glenoid arthrosis after a hemiarthroplasty have marked pain relief and improvement in motion a fter revision to a total shoulder replacement, However, seven of the e ighteen shoulders that had this procedure had an unsatisfactory result due to a limited range of motion or the need for a subsequent operati on, Therefore, long-term studies are necessary to evaluate the durabil ity of total shoulder replacement in this group of patients.