A CT scan demonstrated the severity of the joint destruction.
During surgery we found that the glenoid did not have enough bone stock for insertion of a glenosphere for a reverse shoulder replacement and the rotator cuff (supraspinatus) muscle was torn. The subscapularis was present but was atrophic.
We elected to proceed with a hemiarthroplasty with a large size humeral head to avoid instability and provide some pain relief. Cultures were obtained at the time of surgery that will be held for 3 weeks to look for p. acnes and the patient was placed on oral Augmentin for 3 weeks until cultures finalize.
The post-operative XR shows restoration of the acromion index as described before
(Association of a Large Lateral Extension of the Acromion with Rotator Cuff Tears
This case illustrates the complexity involved in the treatment of shoulder arthritis that is associated with (1) loss of soft tissue balance-rotator cuff (2) loss of glenoid bone stock.
Although some surgeons would have suggested bone grafting of the glenoid and implantation of a reverse shoulder prothesis we elected not to proceed with this approach due to the (1) high chance of absorption of the bone graft at the glenoid (2) history of infection increasing the chances of failure of the bone graft (3) early loosening of the glenosphere in shoulders with hypoplastic, dysplastic or atrophic glenoids.