Wear and osteolysis in total joint replacements.

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Abstract

[Indexed for MEDLINE] 17. J Shoulder Elbow Surg. 2017 Mar;26(3):443-449. doi: 10.1016/j.jse.2016.08.009. Epub 2016 Oct 10. Revisions for aseptic glenoid component loosening after anatomic shoulder arthroplasty. Aibinder WR(1), Schoch B(2), Schleck C(1), Sperling JW(3), Cofield RH(1). Author information: (1)Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA. (2)Department of Orthopedic Surgery, University of Florida, Gainesville, FL, USA. (3)Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: sperling.john@mayo.edu. BACKGROUND: Glenoid component loosening is a common indication for revision shoulder arthroplasty. The objective of this study is to assess the longer-term outcomes of patients undergoing revision specifically for aseptic loosening. MATERIALS AND METHODS: Between 1985 and 2005, 34 revision shoulder arthroplasties were performed for aseptic glenoid loosening. Three patients were lost to follow-up. Treatment included component reimplantation in 20 shoulders (group I) or component removal with bone grafting in 11 shoulders (group II). We identified 9 cases of instability with or without rotator cuff tearing prior to revision. The mean follow-up period was 8.3 years. RESULTS: The rate of survival free of reoperation at 10 years was 78.9% in group I and 83.9% in group II (P = .5). Pain relief occurred in 26 of 31 shoulders, with no difference between groups (P > .99). Active elevation and external rotation improved in both groups (P = .8). Five shoulders in group I had radiographically loose glenoids, with two requiring reoperation. Nine shoulders in group II had medial glenoid erosion, with two requiring reoperation for pain. There was a trend toward reoperation in those with preoperative instability (5 of 8 re-revisions). DISCUSSION AND CONCLUSION: Glenoid revision surgery in the absence of infection provides satisfactory results, especially when instability is not coexisting. When glenoid bone stock permits, reimplantation of a new glenoid component in an active patient with an intact rotator cuff and no instability is reasonable. When the remaining glenoid bone will not support a new component, conversion to a hemiarthroplasty is also reasonable. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jse.2016.08.009