Salvage techniques

In very rare cases of chronic infection and/or insufficient bone stock or quality, permanent removal of prosthetic implant components may be needed.

The surgeon and the patient must be aware that removal of a part or total joint replacement will lead to a significant impairment of the shoulder function.

If the plan is to remove the glenoid component in an anatomic prosthesis, there is no need to change the humeral components in most cases.

If the glenoid component must be removed in a reverse prosthesis, the humeral liner must usually be converted to some type of hemiarthroplasty.

If the plan is to restore the glenoid component, more information is provided in the glenoid revision treatments.

If the humeral component must be permanently removed, the glenoid component is routinely removed as well.

In cases where bone stock is insufficient for proper fixation of new components, a staged procedure may be needed so that bone stock can be augmented initially.

In periprosthetic fractures where infection is confirmed or strongly suspected, a staged procedure with or without the use of an antibiotic loaded spacer may be indicated.

The patient is positioned in the beach chair position.

Patient positioning should be discussed with the anesthetist.

The approach chosen usually depends on the initial surgery.

The methods used for removal of implant components are highly dependent on component design.

Specified removal instruments should be utilized according to surgical techniques provided by the implant manufacturer.

An antibiotic loaded spacer is used:

• As a temporary measure to deliver antibiotics to the shoulder joint space as part of planned staged revision surgery for an infected total shoulder replacement
• As a temporary measure while planning definitive custom implants in cases where either humeral or glenoid bone stock is insufficient after explantation of the primary implants
• Occasionally as the definitive treatment in cases where comorbidities preclude further surgical reconstruction

The options for antibiotic loaded spacers include:

• prefabricated implants containing standard doses of antibiotics
• implants fabricated at the time of surgery to which patient-specific doses of antibiotics can be added

Aftercare following implant removal in salvage cases is usually functional. A sling support is often needed indefinitely. If possible, the patient is encouraged to use the limb for normal daily activities as comfort permits.