Patient Background & Initial Presentation
A 62-year-old female presented to Dr. Brian Badman at Central Indiana Orthopedics with persistent, severe right shoulder pain.
Her medical history was highly complex:
- Extended Hospitalization: She previously underwent a 46-day hospital admission due to severe urosepsis following a total hip replacement.
- Prior Surgical History: She had a prior rotator cuff repair on the same right shoulder.
- Onset of Symptoms: She recalled experiencing right shoulder pain while admitted to the hospital, but received no specific joint treatment at the time other than baseline X-rays.
Clinical & Diagnostic Evaluation
Physical examination revealed:
- Physical Findings: Right shoulder with no obvious redness or warmth. Deltoid muscle function remained fully intact.
- Restricted Range of Motion (ROM):
- Active Forward Flexion (FF): 80°
- Abduction: 70°
- External Rotation (ER): 50°
- Internal Rotation (IR): Reaching to the buttock
Imaging & Complex Diagnostic Findings:
- Diagnostic X-rays and 3D CT Scans revealed severe, rapid glenoid bone loss.
- Although a recent joint aspiration returned negative for active infection ("dry tap" with no bacterial growth), there remained a high clinical suspicion for a missed septic shoulder that caused extensive structural erosion.
Surgical Strategy & Custom Engineering
Reconstructing a shoulder joint with severe glenoid bone loss presents a major challenge. Dr. Badman formulated a specialized, single-stage custom reconstruction plan:
- Custom Medacta Implant System: A custom-engineered patient-specific implant was designed to fit her remaining bone structure.
- Advanced Infection Risk Mitigation: To significantly lower the risk of periprosthetic infection, the custom implant featured Mectashield Nanometric Silver Substrate Coating.
- Pre-Surgical Planning & Tooling: Working directly with Medacta bio-engineers, custom guides, 3D positioners, and patient-specific reamers were created for every step of the procedure.
Surgical Execution
Dr. Badman executed the custom reconstruction through a series of precise steps:
- Joint Exposure: An anterior release was performed to carefully expose the glenoid, navigating significant scar tissue.
- Guide Placement & Fixation: Patient-specific guides were positioned and secured with drill pins.
- Implant Insertion: The custom-coated Medacta glenoid baseplate was inserted and secured into the remaining bone.
- Humeral Preparation: The humerus was reamed and prepped for the matching trial and final stem insertion.
Post-Operative Recovery & Results
At her 4-month post-operative follow-up, imaging confirmed the custom implant remained securely anchored.
4-Month Range of Motion (ROM) Outcomes:
- Forward Flexion (FF): 100° (Improved from 80°)
- Abduction: 95° (Improved from 70°)
- External Rotation (ER): 55° (Improved from 50°)
Conclusion
By combining advanced 3D custom implant engineering with anti-microbial silver substrate technology, Dr. Brian Badman successfully reconstructed a severely compromised shoulder joint, restoring stability, function, and mobility for a patient who faced catastrophic bone loss.
- Surgical Care Team: Dr. Brian Badman | Central Indiana Orthopedics / Indy Shoulder
