PMC8749484_01
Preoperative left shoulder active movement in a 79-year-old man.. a) Elevation of 25 , b) abduction of 45 , c) external rotation of 30 , d) internal
rotation to L5.
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F1
His left shoulder ROM was 40 , 30 , 30 , and to L5 for elevation, abduction, external rotation, and internal rotation, respectively (Figure 1).
Preoperative images.. a) Plain radiography shows an acromio-humeral head interval (AHI) of 2 mm
(red arrow) and glenohumeral joint narrowing (blue arrow). b) CT shows a concaved deformity on
the undersurface of the acromion. c) Coronal multiplanar view shows that the glenoid shape is
type E0 using the Favard classification. d) T2-weighted magnetic resonance imaging shows
detachment of the supraspinatus muscle from the greater tubercle to the glenoid rim (red
arrow). d) Three-dimensional CT image showing that the transverse length of the glenoid is
25 mm (red arrow), with no glenoid deformity. f) Axial CT image showing that the glenoid
shape is type A1 using the Walch classification.
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F2
Plain radiography showed an acromio-humeral interval of 2 mm, with glenohumeral joint narrowing (Figure 2a). Computed tomography (CT) revealed a concaved deformity on the undersurface of the acromion (Figure 2b). Magnetic resonance imaging showed a partial subscapularis tendon tear and global supraspinatus and infraspinatus tendon tears (Figure 2c). Three-dimensional CT imagery revealed that the transverse length of the glenoid was 25 mm, with no glenoid deformity (Figure 2d).
Immediately postoperative images and preoperative planning images.. a) Plain radiography. b) Coronal multiplanar image. c) Preoperative planning
image. The actual center post of the baseplate (red arrow) is higher than preoperatively
planned. The yellow arrow indicates the inferior rim of the glenoid.
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F3
In accordance with the JOA guidelines, we decided to perform RSA (Figure 3). Postoperative radiography and CT showed that the position of the glenoid component was more superior than preoperatively planned (Figure 3).
Images from 5 weeks postoperatively.. a) Plain radiography shows that the baseplate is displaced superiorly (blue
arrow). b) c) Coronal multiplanar and three-dimensional CT images revealing a bone defect at
the superior rim of the glenoid (red arrow).
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F4
We found baseplate loosening, and a glenoid bone defect that had been created by the baseplate loosening (Figure 4).
Images obtained after the second operation.. a) Radiography showing the two cannulated screws inserted to fix the allogenic
bone graft, and a cement spacer inserted in the humeral shaft. b) Three-dimensional CT images
taken immediately after the second operation showing the allogenic bone from the femoral head
grafted on the bone defect of the glenoid (red arrow). c) Three-dimensional CT images taken 6
months after the second operation showing complete union of the allogenic bone graft (red
arrow).
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F5
To maintain the length of the humeral bone, a cement spacer shaped like the humeral head was inserted into the humerus (Figure 5).
Images obtained 2 months after the final operation.. a) Plain radiography. b) Coronal multiplanar CT showing the baseplate with a long
post (13 mm) (red arrow) inserted from the inferior glenoid rim (yellow arrow). c)
Three-dimensional CT.
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F6
A size 2B humeral stem was inserted at 20  retroversion with cement (Figure 6).
Recovery of range of motion at 2 months after the final operation.. The patient achieved the following shoulder active ranges of motion: a) Elevation
of 135 . b) Abduction of 175 . c) External rotation of 40 . d) Internal rotation to L5.
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F7
Two months after the last operation, the left shoulder active ROM was 150 , 150 , 40 , and to L5 for elevation, abduction, external rotation, and internal rotation, respectively (Figure 7).