Posterior Instability After Total Shoulder Arthroplasty
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Arthroscopic Repair of Recurrent Posterior Shoulder Subluxation After Total Shoulder Arthroplasty A Case Report
These authors present the case of a 53-year-old man with osteoarthritis (Walch biconcave [B2] glenoid; 22 degrees of retroversion; glenohumeral subluxation index, 65%) and a partial rupture of the supraspinatus tendon in the left shoulder. The patient had an anatomic total joint replacement. At that time glenoid retroversion was changed from 22 to 5 degrees by reaming the anterior glenoid; in spite of the change in glenoid version, the joint could be subluxated posteriorly; however, because it reduced spontaneously, the reconstruction was considered adequate. The patient experienced 2 posterior subluxations during isometric exercises while still in the hospital and at 9 months the patient experienced worsening shoulder stability.
These authors present the case of a 53-year-old man with osteoarthritis (Walch biconcave [B2] glenoid; 22 degrees of retroversion; glenohumeral subluxation index, 65%) and a partial rupture of the supraspinatus tendon in the left shoulder. The patient had an anatomic total joint replacement. At that time glenoid retroversion was changed from 22 to 5 degrees by reaming the anterior glenoid; in spite of the change in glenoid version, the joint could be subluxated posteriorly; however, because it reduced spontaneously, the reconstruction was considered adequate. The patient experienced 2 posterior subluxations during isometric exercises while still in the hospital and at 9 months the patient experienced worsening shoulder stability.
The surgeons performed arthroscopic reefing of the posterior capsule, which successfully stabilized the shoulder for approximately 9 years; thereafter, the recurrence of instability ultimately required conversion to a reverse prosthesis.
Comment: This case report demonstrates several points:
However, the preoperative CT scan (taken with the arm at the side) shows a biconcave glenoid without apparent posterior decentering with respect to the glenoid face.
The arthroscopic axillary view after successful arthroscopic reefing (taken with the arm elevated) shows no posterior decentering with respect to the glenoid face.
Comment: This case report demonstrates several points:
(1) cuff deficiency can contribute to posterior instability after shoulder arthroplasty
(2) 'correcting' glenoid version does not assure glenohumeral stability
(3) soft tissue balance is critical for centering the humeral head in the glenoid
(4) instability identified at the time of surgery should be addressed at the time of surgery.
The images from this article are also interesting.
The preoperative axillary view (taken with the arm elevated) shows posterior decentering with respect to the glenoid face and a biconcave glenoid
The postoperative axillary view (taken with the arm elevated) shows posterior decentering with respect to the glenoid face in spite of the 'corrected' glenoid version.
The arthroscopic axillary view after successful arthroscopic reefing (taken with the arm elevated) shows no posterior decentering with respect to the glenoid face.
Note the comparability of the axillary views taken with the arm elevated and how informative they are.
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