Revision arthroplasty of the shoulder for painful glenoid loosening: a series of 14 cases followed at four year follow-up

Purpose of the study We present the results of a continuous series of 14 pa tients who underwent revison arthroplasty of the shoulder for painful major loosening of the glenoid component. Material and methods Mean follow-up was four years after revision. Loosenin g was diagnosed seven and a half years after the primary arthroplasty. The diagnosis of loosening was based on the association of a painful impairment of the shoulder with increasing radiolucency or migration of the component . The degree of pain alone guided the surgical decision. The posterior appr oach provided wide exposure. A glenoid component with an acromial fixation was used in all cases. Results The loosening was confirmed in all cases at surgery. Two were early failures of the fixation. The glenoid required a bone graft in all cases. The acromion was a useful landmark for proper positioning of the prosthesis . Fixation with cement and screws provided a strong fixation allowing immed iate rehabilitation exercises. Good fixation of the glenoid component was a chieved in all cases. After seven years follow-up there has been evidence o f iterative loosening in one patient. In another case, one screw broke, sug gesting forthcoming loosening. Twelve cases had no or very little pain. Two painful cases were associated with anterior migration of the humeral head. Discussion Even when the local conditions are unfavorable, good implant fix ation can be achieved by grafting the glenoid bone loss. Functional improve ment is essentially due to pain relief. Conclusion This series, the largest published to date on revision surgery o f painful loosening of total shoulder arthroplasty, demonstrated that itera tive fixation is technically possible and can provide highly significant pa in relief.