Polyethylene wear: an under-reported cause of failed shoulder arthroplasty

Polyethylene (PE) wear after shoulder arthroplasty is a rarely reported cause of failure. The goal of this study was to present the clinical, radiographic, and intraoperative findings in a consecutive series of patients who presented with PE wear after shoulder arthroplasty.

Data of patients who presented with features of PE wear between 2018 and 2024 were reviewed. Patient demographics and historical data regarding index surgery, implant characteristics, and manufacturer information were collected. Upon presentation after index arthroplasty, chief complaints, radiographic features, and clinical examinations were analyzed. Intraoperative findings and surgical management were reviewed in patients who underwent revision.

43 patients were included in this study. The average time after index surgery to initial presentation was 12.1 ± 4.8 years after anatomic total shoulder arthroplasty (aTSA) and 8.3 ± 3.4 years after reverse total shoulder arthroplasty (rTSA). The most common chief complaint was new onset pain for 77% of patients with prior aTSA and new onset instability in 57% of patients with prior rTSA. Most (>80%) aTSA glenoid components and rTSA humeral liners were comprised of conventional, noncrosslinked PE. All patients had radiographic evidence of proximal humeral bone loss. 65% of patients underwent revision with aggressive soft tissue débridement and synovectomy. Implant management was based on bone loss, presence of implant loosening, and soft tissue findings.

Surgeons should be aware of the possible sequelae of PE wear in patients after shoulder arthroplasty, especially those with conventional, noncrosslinked PE. New onset pain and weakness after a symptom-free holiday (years) are common after aTSA. New onset instability and pain after a symptom-free holiday (years) are common after rTSA. Radiographic findings can include humeral and glenoid bone loss, a narrowed glenoid clear space, and eccentricity of the articulation. The diagnosis is provisionally made and confirmed intraoperatively. Revision poses unique challenges and should include aggressive synovectomy, débridement, and individualized bone loss management. Further studies are crucial for understanding this emerging phenomenon after shoulder arthroplasty.