Arthroscopic Removal of a Loose Polyethylene Glenoid Component With Bone Grafting and Patch Augmentation for Glenoid Osseous Defect

Abstract

Glenoid component loosening is a common cause of failed total shoulder arthroplasty. Many different treatment options exist for the management of a symptomatic loose polyethylene glenoid component, ranging from component removal to revision arthroplasty. Arthroscopic removal and conversion to hemiarthroplasty provides a minimally invasive management option that avoids takedown of the subscapularis and allows for humeral prosthesis retention. Frequently, however, osteolysis is encountered concomitantly leading to cavitary glenoid bone deficits at the time of glenoid implant removal, limiting both immediate and future treatment options. The purpose of this Technical Note is to describe in detail an all-arthroscopic technique for removal of a loose polyethylene glenoid component with subsequent bone grafting of a contained glenoid bone defect, and insertion of a human dermal allograft patch.

Fig 1

(A) Axial, (B) coronal, and (C) sagittal computed tomography scan of the right shoulder showing significant osteolysis in a patient with a loose glenoid 17 years after total shoulder arthroplasty. Red arrows depict areas of osteolysis surrounding the polyethylene implant.

Fig 2

Synovitis encountered in the setting of a loose glenoid after total shoulder arthroplasty due to polyethylene debris. An arthroscopic shaver can be used to debris the surrounding synovitis, and its mirrored appearance can be seen reflected off of the humeral component. Right shoulder, lateral decubitus position—viewing from the posterior portal. (GI, glenoid implant; HI, humeral implant; S, synovitis.)

Fig 3

Confirmation of a loose glenoid with an elevator detecting gross motion. (A) The elevator is introduced, and (B) it easily slides underneath the glenoid component and with leverage shows gross motion. Right shoulder, lateral decubitus position—viewing from the posterior portal. (GI, glenoid implant.)

Fig 4

Saucerization of the loose glenoid with an arthroscopic biter can aid with removal of the component in a piecemeal fashion. Right shoulder, lateral decubitus position—viewing from the posterior portal. (GI, glenoid implant; HI, humeral implant.)

Fig 5

Removal of loose polyethylene component. (A) Visualization and removal of large portions of a loose glenoid and surrounding bone cement. The peg portions of the glenoid component can be removed arthroscopically by transecting with an osteotome. Right shoulder, lateral decubitus position—viewing from the anterosuperior portal. (B) Extra-articular view of the removed glenoid component. (G, glenoid; GI, glenoid implant; HI, humeral implant.)

Fig 6

Arthroscopic bone grafting of a residual glenoid defect. (A) Viewing from the posterior portal, a heat ablator is visualized inserted into the depth of the glenoid defect after cement and polyethylene removal. (B) An arthroscopic cannula is filled with bone chips and introduced into the bone defect. Introduction via an arthroscopic cannula helps to prevent loss of fine bone graft particles in the soft tissues. (C) Free corticocancellous chips are introduced and tamped into place. (D) The defect is filled and grafting is completed. Right shoulder, lateral decubitus position. (BG, bone graft; G, glenoid; GD, glenoid defect; HI, humeral implant.)

Fig 7

A human dermal allograft has been inserted over the surface of the glenoid with anchors placed at the 5 and 7 o'clock positions, respectively. This provides inferior security of the graft. The humeral head component is visualized superiorly in the photograph. Right shoulder, lateral decubitus position—viewing from the posterior portal. (DA, dermal allograft; HI, humeral implant.)

Fig 8

(A) Posterior and (B) anterosuperior portal viewing of the completed human dermal allograft patch. This serves to resurface the glenoid and to help contain the underlying bone grafting. Right shoulder, lateral decubitus position. (DA, dermal allograft; HI, humeral implant.)