Glenoid loosening after a total shoulder in a body builder

Wednesday, June 4, 2014

Glenoid loosening after a total shoulder in a body builder

A 50 year old body builder from the other corner of the country had a total shoulder arthroplasty in 2011 for degenerative arthritis. There was persistent pain after surgery, so several months later, the surgeon did a biceps tenotomy.  Several months later, an acromioplasty was performed because of persistent pain.

The x-rays below were sent to us along with a request for consultation. What do you see on the films?

Because of the glenoid loosening seen on each of the three views, we invited the patient out for a visit. The patient complained of inability to use the shoulder and a clunking on movement,
We obtained these views

 which show glenoid loosening with fractured cement.

At revision surgery, the glenoid was completely loose, there was a layer of fibrous tissue over the glenoid bone, there were many pieces of loose cement around the joint and the humeral head was in 80 degrees of retroversion.

The glenoid component was removed, an eccentric inferior humeral head component was placed, the soft tissues were balanced, and the subscapularis securely repaired. The glenoid was not bone grafted.

The post operative films are shown here.

The shoulder was started on immediate assisted motion to 150 degrees.

The patient notes the absence of clunking and is vigorously pursuing rehabilitation in anticipation of being able to return to weight lifting without worry about glenoid component loosening.