title: Aseptic glenoid loosening or failure in total shoulder arthroplasty: revision with glenoid reimplantation.
abstract: OBJECTIVE
  Reimplantation of a new glenoid component for symptomatic glenoid failure after total shoulder arthroplasty (TSA) is a well-established surgical strategy. In case of aseptic glenoid loosening or failure, revision of TSA by reimplantation of a cemented glenoid implant would be a reliable therapeutic option.
  
  
  METHODS
  This retrospective multicenter study included 42 TSAs with symptomatic failed glenoids revised by reimplantation of an all-polyethylene (PE), cemented glenoid component. All patients were reviewed clinically and radiologically, with a mean follow-up of 74 months.
  
  
  RESULTS
  The failed initial glenoid component was metal backed in 32 cases and PE cemented in 10. The main cause of glenoid failure was component loosening in 19 cases (46%) and PE wear or dissociation in 23 (54%). Associated complications were very frequent, including rotator cuff tears, subscapularis insufficiency, and prosthesis instability. At last follow-up, 7 patients (17%) had already been re-revised because of symptomatic recurrent glenoid loosening. The overall rate of recurrent glenoid loosening (re-revision plus radiologic loosening) was 67%. Soft-tissue problems and prosthetic instability were significantly associated with recurrent loosening. Of the 10 associated bone grafts performed during the revision procedure, all were partially or totally lysed. At follow-up, the mean Constant score was 57 points (gain of 16 points) and the mean active anterior elevation was 125° (gain of 19°).
  
  
  CONCLUSIONS
  This study suggests that revision of a TSA with reimplantation of an all-PE cemented glenoid component does not solve the problem of glenoid loosening. Soft-tissue failure and prosthetic instability are underestimated preoperatively and may explain, in part, the high rate of recurrent glenoid loosening.
authors.affiliation: Hôpital de L'Archet 2, Nice, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonnevialle
authors.forename: Barbara
authors.initials: B
authors.lastname: Melis
authors.forename: Lionel
authors.initials: L
authors.lastname: Neyton
authors.forename: Luc
authors.initials: L
authors.lastname: Favard
authors.forename: Daniel
authors.initials: D
authors.lastname: Molé
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
mesh_terms: D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*