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Review
. 2023 Oct;15(10):2736-2740.
doi: 10.1111/os.13832. Epub 2023 Aug 1.

Metallosis-Induced Conversion Shoulder Arthroplasty: A Unique Experience and Literature Review

Jong-Hun Ji  1 , Sang-Eun Park  1 , Darshil Parikh  1 , Woojin Lee  1 , Jinyoung Jeong  2 , Hyun Woo Park  2 , Seungbae Oh  2
Affiliations
Review

Metallosis-Induced Conversion Shoulder Arthroplasty: A Unique Experience and Literature Review

Jong-Hun Ji et al. Orthop Surg. 2023 Oct.

Abstract

Background: Total shoulder arthroplasty (TSA) can fail for several reasons, such as component loosening, periprosthetic fracture, instability, infection, soft tissue failure, or joint overstuffing. Severe metallosis without loose glenoid components after TSA may result in the need for revision to reverse TSA.

Case presentation: Four years before the current presentation, an 86-year-old woman suffered from right shoulder pain and swelling. The initial diagnosis was osteoarthritis of the shoulder joint, for which she underwent TSA. Four years later, she complained of shoulder joint pain, swelling, and limited range of motion. On sonography, subscapularis and supraspinatus tendon tears were identified. Plain radiographs and computed tomography (CT) scans showed metallosis around the shoulder joint. Due to the rocking horse mechanism, wear of the upper portion of the glenoid component and bearing caused a foreign-body reaction and severe metallosis around the joint. Due to a massive rotator cuff tear combined with glenoid component wear, the patient eventually underwent reverse TSA (RTSA) and was satisfied with the final results.

Conclusions: Severe metallosis due to glenoid component wear combined with a massive rotator cuff tear in TSA may cause the need for revision to RTSA.

Keywords: Prosthesis Loosening; Reverse; Rotator Cuff Tears; Total Shoulder Arthroplasty; Total Shoulder Arthroplastymetallosis.

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Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this report.

Figures

Fig. 1
Fig. 1
Eighty milliliters of dark‐colored joint fluid was aspirated from the shoulder joint.
Fig. 2
Fig. 2
X‐ray of metallosis in the shoulder joint: (A) postoperative X‐ray showed normal component positioning without any loosening (arrow); and (B) on X‐ray 4.6 years after surgery, severe metallosis (metallic staining in the shoulder joint) was found around the shoulder joint (dotted arrow) and in the upper one‐third of the glenoid basement component that was worn out (arrow) by the anterosuperior escape of the humeral head.
Fig. 3
Fig. 3
Contrast‐enhanced computed tomography scans showed rim‐enhanced and non‐enhanced fluid collection around the sub‐acromial bursa (A, arrow), subdeltoid (B, arrow), and glenohumeral joint (C, arrow).
Fig. 4
Fig. 4
Intraoperative findings: (A) thin and elongated subscapularis tendon was found; and (B) torn subscapularis and supraspinatus tendons are shown, with metallosis debris shown in the glenohumeral joint and proximal humerus; (C) wear of the upper portion of the glenoid component is shown clearly in the glenohumeral joint; and (D) the glenoid bearing is worn out and already displaced from the baseplate.
Fig. 5
Fig. 5
Postoperative X‐ray: (A) conversion of total shoulder arthroplasty to reverse shoulder arthroplasty with convertible arthroplasty system; and (B) the follow‐up X‐ray performed 1 year after surgery showed normal component positioning without any loosening.
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