[Shoulder prosthesis replacement options : New implants, treatment algorithms and clinical results]

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Radiology

Background:

• Bone defects are common and complex issues in shoulder revision arthroplasty.
• Aseptic/septic loosening and implant removal can lead to significant humeral and/or glenoid bone loss.
• These defects increase the complexity of revision procedures.

Purpose of the Study:

• To review diagnostic imaging and surgical techniques for shoulder revision arthroplasty with bone loss.
• To outline strategies for managing glenoid and humeral bone defects.
• To discuss modern prosthesis designs and bone reconstruction methods.

Main Methods:

• Preoperative imaging for defect assessment and surgical planning.
• Intraoperative re-evaluation of bone defects after implant removal.
• Utilizing autologous/allogenic bone grafts and metallic augmented implants for glenoid reconstruction.
• Employing longer revision stems and allograft augmentation for humeral defects.
• Addressing soft tissue loss with fixation techniques.
• Leveraging modular prosthesis designs for revision.

Main Results:

• Careful preoperative imaging is crucial for planning bone reconstruction.
• Intraoperative assessment is necessary for larger defects.
• Various graft and implant options exist for glenoid and humeral reconstruction.
• Modular prostheses facilitate revision while preserving integrated components.

Conclusions:

• Effective management of bone loss in shoulder revision arthroplasty requires meticulous preoperative planning and intraoperative adaptation.
• A range of reconstructive techniques, including grafts and augmented implants, are available.
• Modern implant designs offer flexibility in revision surgery.