An unusual complication after shoulder hemiarthroplasty

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Medical Device Complications

Background:

• Shoulder hemiarthroplasty is a recognized treatment for rheumatoid arthritis (RA)-related shoulder pain.
• Common complications include dislocation, loosening, periprostrosthetic fractures, and infection.
• Aseptic sinus formation due to prosthesis displacement is a rare but significant complication.

Purpose of the Study:

• To report a unique case of aseptic sinus formation secondary to shoulder hemiarthroplasty in a patient with rheumatoid arthritis.
• To describe the mechanism of clavicle erosion and displacement leading to the sinus formation.
• To present the successful surgical management of this complication.

Main Methods:

• Case report of a patient with rheumatoid arthritis who developed a discharging sinus after shoulder hemiarthroplasty.
• Detailed description of the radiological and clinical findings, including prosthesis displacement and acromioclavicular (AC) joint erosion.
• Surgical intervention involving exploration and excision of the distal clavicle.

Main Results:

• The patient presented with a discharging sinus over the acromion tip.
• Radiographic and clinical evaluation revealed prosthesis displacement, AC joint erosion, and distal clavicle erosion.
• The eroded clavicle migrated posteriorly, penetrating the trapezius muscle and skin, forming an aseptic sinus.
• Surgical exploration and excision of the distal 2 cm of the clavicle successfully resolved the sinus.

Conclusions:

• Shoulder hemiarthroplasty complications, though uncommon, can be severe and require specific management.
• Clavicle erosion and posterior displacement can lead to aseptic sinus formation, a rare sequela.
• Surgical excision of the eroded clavicle fragment is an effective treatment for this specific complication.