Recurrent Prosthesis Loosening s/p RTSA for Fx in 68F

HPI

A 68-year-old female presents in November of 2022 for a second opinion, with a chief complaint of shoulder pain that wakes her up at night, declining function, and a known history of recurrent prosthesis loosening. Her pain has worsened to the point that it is difficult for her to sleep. In March of 2021 the patient presented with an isolated R proximal humerus fracture. The patient was NVI. She underwent a cemented RTSA for fracture at an OSH. 5 Months after her primary RTSA, in August of 2021, she developed progressive pain and discomfort. She was diagnosed with progressive loosening of the humeral component by the original surgeon. She was noted to have increasing pain, redness, and erythema at the incision and low-grade fever. She was treated with a two-stage revision to a mega-prosthesis, with the definitive reconstruction being performed in November of 2021. Due to her history of infection, a comprehensive infection workup was performed. An image-guided aspiration was performed and was negative. Serum labs, including an ESR, WBC, and CRP, are equivocal.

PMH

Unremarkable other than HPI.

PE

On physical exam, her Incision is well healed. There is mild lateral erythema, but no drainage. She has a Forward elevation of 90 degrees, External rotation of 10 degrees, Internal rotation to the sacrum, and deltoid strength of 5 of 5.