title: Uncemented metal-back glenoid component in revision of aseptic glenoid loosening: a prospective study of 10 cases with a minimum follow-up of 2 years.
abstract: BACKGROUND
  Glenoid component loosening comprises 25 % of all complications related to total shoulder arthroplasties (TSA). This prospective study was undertaken to assess the accuracy of an uncemented metal-back glenoid component in cases of revision of aseptic glenoid loosening.
  
  
  METHODS
  Between September 2007 and January 2010, a total of ten patients with symptomatic glenoid loosening after TSA (7 cemented and 3 non-cemented) underwent revision surgery with an uncemented metal-back glenoid component (MB). The rotator cuff was functional in all cases. The reconstruction of the glenoid was obtained using an iliac crest graft (8 patients) or synthetic bone substitute (2 patients). The non-cemented glenoid component was fixed into the glenoid native bone, thus stabilizing the graft reconstruction. A clinical and radiological checkup was performed at the long-term follow-up and compared with the preoperative values. The patients were also asked to quantify their pain and satisfaction.
  
  
  RESULTS
  There were no intraoperative complications. In all cases, the radiological evaluation showed a good integration of the bone graft with no radiolucency or new glenoid loosening. In one patient, the revision surgery was indicated for the dissociation between MB and polyethylene. After more than 2 years of follow-up, all patients were satisfied or highly satisfied with the outcomes. The pain VAS score (0-10) decreased from 5.1 to 0.6 (p < 0.001). The simple shoulder test increased from 3.4 to 7.9 points (gain 4.5; p < 0.001). The Constant and Murley score increased from 39.4 to 71 points (gain 31.6; p < 0.001). The gain in anterior elevation was 31°, from 118° to 149° (p < 0.001). External rotation elbow to the body (ER1) increased from an average of 34° preoperatively to 47° after surgery (p < 0.001) and external rotation at 90° of abduction from 43° to 66° (p < 0.001).
  
  
  CONCLUSIONS
  This study suggests that revision with a non-cemented glenoid component associated with a bone graft can solve the difficult challenge of glenoid loosening, provided that the rotator cuff is functional and the glenoid is reconstructable.
  
  
  METHODS
  Cohort studies (prospective) without controls, Level IV.
authors.affiliation: Institut de la Main, Clinique Jouvenet, 6 Square Jouvenet, 75016, Paris, France, Philippe.valenti@wanadoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Valenti
authors.forename: Pablo
authors.initials: P
authors.lastname: Valle
authors.forename: Philippe
authors.initials: P
authors.lastname: Sauzieres
authors.forename: Omar
authors.initials: O
authors.lastname: Boughebri
authors.forename: Tina
authors.initials: T
authors.lastname: Moraiti
authors.forename: Ali
authors.initials: A
authors.lastname: Maqdes
authors.forename: Christian K
authors.initials: CK
authors.lastname: Spies
authors.forename: Frank
authors.initials: F
authors.lastname: Unglaub
authors.forename: Franck Marie
authors.initials: FM
authors.lastname: Leclère
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008670:Metals; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation; D012540:Scapula / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D008670:Metals