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15–21-Year Results of Unconstrained Total Shoulder Arthroplasty: The “Floating Glenoid” Threat

Sébastien Zilber, MD, Catherine Radier, MD, James Huddleston, MD.

This article presents the outcomes of eight unconstrained total shoulder arthroplasties (TSAs) performed in six patients with centered glenohumeral arthropathies. Outcomes were evaluated using physical examination, radiographic examination, and histological analysis at a minimum of 15 years of follow-up (mean 18 years). The preoperative diagnosis was osteoarthritis in four shoulders and inflammatory arthritis in the other four. Over the follow-up period, the mean non-weighted Constant score increased by 23 points (standard deviation [SD] 20 points). Radiographs demonstrated a mean humeral head penetration of 6.5 mm (SD 3.5 mm). Computed tomography (CT) scans revealed a “floating glenoid” in four patients. Histological analysis of two of these patients who underwent revision revealed granuloma formation with polyethylene and cement debris. Evaluation of this cohort suggests that the primary mechanism of TSA failure is osteolysis triggered by aseptic loosening of the glenoid component. The authors recommend that all TSA patients undergo routine surveillance with CT after the prosthesis has been in place for >10 years. Replacement of the glenoid component should be considered in patients whose components have loosened before the development of a floating glenoid and a subsequent reduction in function. Adv Orthop 2008;1(1):17–22.

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