Techniques and Tips to Arthroscopically Remove Prominent and Loose Shoulder Joint Hardware

Abstract

The number of arthroscopic shoulder operations has continued to steadily increase in recent years, with a projection of over 500,000 rotator cuff operations in 2023. Although the incidence of anchor pullout, hardware failure, and aberrant hardware placement is relatively low, this increased volume of shoulder operations has inevitably resulted in a consequent increase in the number of patients who experience such hardware complications. These hardware issues can cause significant pain, limit shoulder function, and cause permanent damage to the shoulder articular cartilage. The described arthroscopic techniques are presented to provide tools and strategies to safely and effectively remove prominent and loose shoulder joint hardware.

Fig 1

An arthroscopic grasper is shown securing a loose suture anchor in a lengthwise and parallel fashion (arrow) in a left shoulder with the patient in the beach-chair position.

Fig 2

When the surgeon is unable to secure loose hardware in a lengthwise fashion or the implant is larger than the diameter of the arthroscopic cannula, the cannula can be retracted and removed in tandem with the grasper, as shown in a left shoulder with the patient in the beach-chair position.

Fig 3

A loose metal screw is removed with an arthroscopic grasper by securing the screw in a lengthwise and parallel orientation (arrow), as shown in a left shoulder with the patient in the beach-chair position.

Fig 4

Two well-fixed parallel screws are placed to secure a posterior bone block that inadvertently violated the articular cartilage of the glenoid, as shown in a left shoulder with the patient in the beach-chair position. The surgeon removes both screws by initially using an appropriate screwdriver to loosen the screws, followed by securing and retrieving these screws arthroscopically using a grasper (arrow) placed parallel to the screw orientation.

Fig 5

Extensive articular cartilage damage (arrows) to both the glenoid and humeral head articular surface is noted in cases in which prominent hardware is present.

Fig 6

A prominent anterior glenoid metallic staple (A) is loosened by sequentially advancing a small handheld osteotome (B) into the glenoid around the staple’s perimeter through an arthroscopic cannula, as shown in a right shoulder with the patient in the beach-chair position.

Fig 7

Once the metallic staple has been adequately mobilized using the handheld osteotome, it can be removed using an arthroscopic grasper, as shown in a right shoulder with the patient in the beach-chair position.

Fig 8

(A) The grasper does not have a secure grasp on the anterior glenoid metallic staple, emphasizing the importance of maximizing the security of the hold on the implant, as shown in a right shoulder with the patient in the beach-chair position. (B) The grasper is repositioned to have a more secure grasp on the implant prior to its removal, as shown in a right shoulder with the patient in the beach-chair position.

Fig 9

After the staple has been removed, some degree of glenoid and humeral head damage can be noted (arrow), as shown in a right shoulder with the patient in the beach-chair position.