[Results of revision surgery for glenoid loosening: a multicentric series of 37 shoulder prosthesis].
OBJECTIVE
The purpose of this study was to assess outcome after revision total shoulder arthroplasty as a function of therapeutic options.


METHODS
Revision total shoulder arthroplasty procedures were performed in three French centers specialized in shoulder surgery. Mean follow-up was 28.5 Months (range 12-69). Constant's score was determined preoperatively and at last follow-up. Nineteen reimplantations of a cemented glenoid, twelve "glenoplasties" without reimplantation and five inverted prosthesis implantations were performed. Arthroplastic resection was performed in one patient with infection.


RESULTS
The function score improved in all patients. Reimplantation of a cemented glenoid led to significant improvement in function at last follow-up. For patients without reimplantation, bone graft reconstruction of the bone loss led to better results than simple removal of the loosened implant. For patients with cuff tears, use of an inverted prosthesis led to improved clinical scores, particularly for pain. Two patients experienced repeated loosening of cemented glenoids and one patient developed infection requiring a second revision.


CONCLUSIONS
Different therapeutic options can be proposed for patients with glenoid loosening. Simply removing the implant is effective in relieving pain but has a modest effect on motion. This type of procedure should be reserved for frail patients requiring an intervention with limited goals. The remaining amount of glenoid bone stock is the key to functional outcome after surgical repair. Glenoid reimplantation can be attempted if only a moderate amount of bone has been lost. Unlike cortical grafts, pure cancellous grafts do not allow reliable reconstruction. After grafting, reimplantation of the glenoid implant can be achieved in a two-stage procedure. Screwed glenoid implants allow fixing the graft in a single operation in better conditions than cemented implants. Inverted prostheses offer a therapeutic solution worth developing for patients with rotator cuff tears and glenoid loosening.
Neyton
L
L
Clinique Sainte-Anne-Lumière, 85, cours Albert-Thomas, 69003 Lyon.
Sirveaux
F
F
Roche
O
O
Molé
D
D
Boileau
P
P
Walch
G
G
D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods*; D001843:Bone Cements; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
D001843:Bone Cements