[Revision arthroplasty of the shoulder for painful glenoid loosening: a series of 14 cases with acromial prostheses reviewed at four year follow up].
OBJECTIVE
We present the results of a continuous series of 14 patients who underwent revision arthroplasty of the shoulder for painful major loosening of the glenoid component.


METHODS
Mean follow-up was four years after revision. Loosening 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 approach 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 immediate rehabilitation exercises. Good fixation of the glenoid component was achieved in all cases. After seven years follow-up there has been evidence of iterative loosening in one patient. In another case, one screw broke, suggesting forthcoming loosening. Twelve cases had no or very little pain. Two painful cases were associated with anterior migration of the humeral head.


CONCLUSIONS
Even when the local conditions are unfavorable, good implant fixation can be achieved by grafting the glenoid bone loss. Functional improvement is essentially due to pain relief.


CONCLUSIONS
This series, the largest published to date on revision surgery of painful loosening of total shoulder arthroplasty, demonstrated that iterative fixation is technically possible and can provide highly significant pain relief.
Gagey
O
O
Service d'Orthopédie Traumatologie, Hôpital Universitaire de Bicêtre,, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre. olivier.gagey@bct.ap-hop-paris.fr
Pourjamasb
B
B
Court
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000295:instrumentation / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome