Principles of glenoid component design and strategies for managing glenoid bone loss in revision shoulder arthroplasty in the absence of infection and rotator cuff tear.

摘要

The number of total shoulder arthroplasty (TSA) cases continues to grow each year. With the increasing number of procedures being performed, there, in turn, will exist a greater need for revision procedures. Failure of a shoulder arthroplasty can result from soft-tissue problems, bony deficiencies, infection, and component wear or loosening. Component loosening and osseous deficiencies may occur on the humeral and/or glenoid side. Multiple studies have identified glenoid component loosening as one of the more common causes necessitating revision after TSA.Glenohumeral joint instability in the setting of rotator cuff deficiency is also a common cause of glenoid loosening. Eccentric loading of the glenoid from proximal humeral migration leads to increased stress at the bone-cement or bone-implant interface, commonly referred to as the "rocking horse phenomenon." Eccentric loading, instability, and glenoid loosening may also result from incomplete glenoid seating, glenoid or humeral component malpositioning, or tuberosity malunion.