Edorium Journal of

Orthopedics

 
     
Case Report
 
Metallosis after reverse total shoulder arthroplasty
Alexander J. Rondon11, Tyler R. Clark1, Felix H. Savoie1
1Tulane School of Medicine, Department of Orthopaedics, Tulane Avenue, SL-32, New Orleans, LA.

Article ID: 100007O03AR2017
doi:10.5348/O03-2017-7-CR-3

Address correspondence to:
Alexander J. Rondon MS
Tulane School of Medicine, Department of Orthopaedics
Tulane Avenue, SL-32
New Orleans

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How to cite this article
Rondon AJ, Clark TR, Savoie FH. Metallosis after reverse total shoulder arthroplasty. Edorium J Orthop 2017;3:17–23.


ABSTRACT

Introduction: We present a case of metallosis following a reverse total shoulder arthroplasty. We are not aware of any cases described in literature of metallosis following reverse total shoulder arthroplasty with well-fixed implants. To date, there have been four cases described in literature that have found metallosis following shoulder replacement surgery: three following hemiarthroplasty and one following total shoulder arthroplasty.
Case Report: Our patient dislocated seven months postoperatively, and with concern of further instability as noted on examination, the patient was taken to the operating room for glenosphere and liner exchange. During surgery, severe metallic staining was discovered in the joint as well as significant inferomedial wear to the polyethylene insert. This was likely due to instability as a result of inadequate tension on the deltoid muscle, inadequate liner size, early hypermobility, downward tilt of the glenoid, and failure to lateralize the component sufficiently. It is our hypothesis that the glenoid component articulated with the metal humeral neck due to asymmetric polyethylene wear of the humeral cup. This likely led to metal-on-metal wear and allowed the release of metal ions into the local environment.
Conclusion: Future consideration must be given to the size and angle of the humeral and glenoid components in reverse total shoulder arthroplasties. It is our hope that our case emphasizes the importance of proper prosthetic placement and establishes a higher level of suspicion for metallosis as a complication for reverse total shoulder arthroplasties.

Keywords: Arthroplasty, Metallosis, Reverse, Shoulder


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Author Contributions
Alexander J. Rondon – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tyler R. Clark – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Felix H. Savoie – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Alexander J. Rondon et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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