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It is the second most common cause of TSA failure after infection
27%
309/1140
It is twice as common following revision surgery than primary TSA
15%
174/1140
Preoperative posterior glenoid wear is a risk factor
45%
514/1140
Presence of radiolucent lines correlates with symptoms
9%
101/1140
Results from failure to cement central peg of the polyethylene component
3%
31/1140
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This patient's radiographs reveal a loose glenoid component in the setting of no infection. Preoperative posterior glenoid wear is a known risk factor for glenoid component loosening. Glenoid component loosening is the most common cause of TSA failure, comprising 30% of primary OA revisions. Known risk factors include insufficient glenoid bone stock such as posterior glenoid wear, and rotator cuff deficiency. Interestingly, radiolucency around the glenoid component does not always correlate with clinical failure and has been shown to not correlate with symptoms. However, progression of the radiolucency has been shown to correlate with symptoms. Treatment may consist of glenoid removal if there is sufficient bone stock. Bone grafting of defects may allow future glenoid implantation. Conversion to reverse shoulder arthroplasty would be a salvage procedure in this younger patient. Cheung et al. reviewed glenoid component loosening after total shoulder arthroplasty. They reported on the outcomes of patients who underwent revision for glenoid component loosening that were treated with either placement of a new glenoid component or removal and bone grafting without glenoid reimplantation. They concluded that glenoid revision surgery will often lead to pain relief and patient satisfaction with a slight clinical benefit to reimplanting a glenoid component whenever structurally possible. Walch et al. reviewed preoperative radiographic measurements with outcomes following TSA. They reported that posterior glenoid bone erosion was significantly associated with glenoid loosening. They concluded that in patients with posterior wear, alternative treatment options, such as reverse shoulder arthroplasty, should be considered. Figure A demonstrates a well placed anatomic total shoulder arthroplasty with no evidence of glenoid loosening. Figure B demonstrates glenoid component loosening as evident by radiolucent lines. Incorrect Answers: Answer 1: Glenoid component failure is the most common cause of TSA failure, comprising 30% of primary OA revisions Answer 2: Glenoid component loosening is significantly more common following revision TSA compared with primary TSA; 28% and 2.9% reoperation rate for loosening, respectively Answer 4: The presence of radiographic lines does NOT correlate with symptoms. Answer 5: In non-keeled polyethylene glenoid components, most central pegs do not require cementation; this is not a risk factor of loosening
1.0
(7)
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