Fracture of a reverse total shoulder arthroplasty retentive liner.

Reverse shoulder arthroplasty may be indicated in shoulders that cannot be effectively managed by conventional reconstruction procedures. Reported complications include instability, infection, hematoma, scapular notching, and premature component loosening. To our knowledge, however, fracture of a humeral component polyethylene inlay has not been described. A 72-year-old man presented with unstable, painful shoulders after undergoing unsuccessful open repairs and acromioplasties at an outside institution for bilateral massive rotator cuff tears. We performed a left reversed shoulder arthroplasty with a 36-mm glenosphere and a +9-mm polyethylene liner. In the operating room under general anesthesia with chemical paralysis and an interscalene block, his shoulder was stable. The patient required revision with a metal 9-mm lateralizer following an atraumatic dislocation 4 weeks postoperatively. Four weeks following the revision, the patient again presented with a dislocated left shoulder without antecedent trauma. During this second revision, the +6-mm standard polyethylene liner was replaced with a +6-mm lateral retentive polyethylene liner. A third revision surgery was performed after the patient experienced 2 more dislocations with minor activity. Intraoperatively, a fracture of the previously placed +6-mm retentive polyethylene liner was noted. This article may represent a case of dramatic scapular impingement by the humeral components. More subtle forms of scapular notching are common and may suggest significant long-term problems. Many reverse shoulder prostheses are being refined or modified in an attempt to eliminate or reduce the scapular notching phenomenon.

Infected total knee arthroplasty: diagnosis and treatment.

Infection following total knee arthroplasty is a challenging complication for both the patient and the surgeon. Precautions to prevent infection include the use of prophylactic antibiotics, minimized surgical time, and meticulous surgical technique. A patient's risk factors should be thoroughly assessed and medical comorbidities should be treated before surgery. When infection is suspected, prompt evaluation of the patient is necessary. The management of a TKA infection is dictated by the duration of symptoms, suspicion for infection, time since index surgery, the patient's willingness and medical capability for undergoing multiple surgeries, the bacteria's sensitivity to antibiotics, and the surgeon's ability to perform complex surgery. Acute infections are treated with aggressive débridement and parenteral antibiotics. In appropriate circumstances, chronic infections are best treated with two-stage reimplantation, which can reliably eradicate infection, relieve pain, and restore good function.