Revision of Failed Total Shoulder Arthroplasty to Hemiarthroplasty due to Glenoid Loosening
Authors: RM Carroll et al.
References: Presented at AAOS 2003
We present the results of 12 consecutive patients who underwent revision of failed total shoulder arthroplasty (TSA) to hemiarthroplasty (HHR) for the treatment of glenoid loosening with deficient glenoid bone stock. METHODS: Between 1988 and 2000, 12 patients underwent revision to HHR for glenoid loosening. All patients had insufficient bone stock for glenoid reimplantation. There were 7 males and 5 females. One patient was lost to follow-up, and two patients had died but had sufficient clinical follow-up for inclusion. The average age at time of the revision procedure was 64 years (41-81). The average interval from index procedure to revision was 5.5 years (6 months-21 years). Patients were evaluated clinically and with standard questionnaires evaluating functional outcome and pain. RESULTS: At an average of 6.5 years (2-11) postoperatively, there were 3/11 (27%) excellent, 5/11 (46%) satisfactory, and 3/11 (27%) unsatisfactory results according to Neer's criteria. The final pain score averaged 0.85 (0-4.5). The final American Shoulder and Elbow Surgeons score averaged 78 (45.8-98). The simple shoulder test averaged 6.4(2-11). Forward elevation improved an average of 26¥. External rotation improved an average of 15¥. 8/9 patients were satisfied with the revision procedure. 7/9 would undergo the procedure again. DISCUSSION: Failed TSA with deficient glenoid bone stock is a complex surgical problem with few reliable reconstructive options. Based on our experience, we prefer to remove the glenoid prosthesis and convert to HHR. Our data shows that this technique results in consistent pain relief and satisfactory results in the majority of patients.