Arthroscopic Removal of a Loose Polyethylene Glenoid Component With Bone Grafting and Patch Augmentation for Glenoid Osseous Defect  Jeffrey T. Abildgaard, M.D., Jared C. Bentley, M.D., Richard J. Hawkins, M.D., John M. Tokish, M.D.  Arthroscopy Techniques  Volume 6, Issue 3, Pages e529-e535 (June 2017) DOI: 10.1016/j.eats.2016.11.011 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Axial, (B) coronal, and (C) sagittal computed tomography scan of the right shoulder showing significant osteolysis in a patient with a loose glenoid 17 years after total shoulder arthroplasty. Red arrows depict areas of osteolysis surrounding the polyethylene implant. Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Synovitis encountered in the setting of a loose glenoid after total shoulder arthroplasty due to polyethylene debris. An arthroscopic shaver can be used to debris the surrounding synovitis, and its mirrored appearance can be seen reflected off of the humeral component. Right shoulder, lateral decubitus position—viewing from the posterior portal. (GI, glenoid implant; HI, humeral implant; S, synovitis.) Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Confirmation of a loose glenoid with an elevator detecting gross motion. (A) The elevator is introduced, and (B) it easily slides underneath the glenoid component and with leverage shows gross motion. Right shoulder, lateral decubitus position—viewing from the posterior portal. (GI, glenoid implant.) Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Saucerization of the loose glenoid with an arthroscopic biter can aid with removal of the component in a piecemeal fashion. Right shoulder, lateral decubitus position—viewing from the posterior portal. (GI, glenoid implant; HI, humeral implant.) Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Removal of loose polyethylene component. (A) Visualization and removal of large portions of a loose glenoid and surrounding bone cement. The peg portions of the glenoid component can be removed arthroscopically by transecting with an osteotome. Right shoulder, lateral decubitus position—viewing from the anterosuperior portal. (B) Extra-articular view of the removed glenoid component. (G, glenoid; GI, glenoid implant; HI, humeral implant.) Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Arthroscopic bone grafting of a residual glenoid defect. (A) Viewing from the posterior portal, a heat ablator is visualized inserted into the depth of the glenoid defect after cement and polyethylene removal. (B) An arthroscopic cannula is filled with bone chips and introduced into the bone defect. Introduction via an arthroscopic cannula helps to prevent loss of fine bone graft particles in the soft tissues. (C) Free corticocancellous chips are introduced and tamped into place. (D) The defect is filled and grafting is completed. Right shoulder, lateral decubitus position. (BG, bone graft; G, glenoid; GD, glenoid defect; HI, humeral implant.) Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 A human dermal allograft has been inserted over the surface of the glenoid with anchors placed at the 5 and 7 o'clock positions, respectively. This provides inferior security of the graft. The humeral head component is visualized superiorly in the photograph. Right shoulder, lateral decubitus position—viewing from the posterior portal. (DA, dermal allograft; HI, humeral implant.) Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 8 (A) Posterior and (B) anterosuperior portal viewing of the completed human dermal allograft patch. This serves to resurface the glenoid and to help contain the underlying bone grafting. Right shoulder, lateral decubitus position. (DA, dermal allograft; HI, humeral implant.) Arthroscopy Techniques 2017 6, e529-e535DOI: (10.1016/j.eats.2016.11.011) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions