Monday, July 22, 2013

Total shoulder with bone graft for osteoarthritis and glenoid erosion

Clinical and Radiographic Outcomes of Total Shoulder Arthroplasty with Bone Graft for Osteoarthritis with Severe Glenoid Bone Loss

The authors point out that glenohumeral osteoarthritis is frequently associated posterior glenoid bone loss and glenoid retroversion [we would add posterior displacement of the humeral head to the list].

The authors report 12 patients having two or more year followup after total shoulder arthroplasty with an all polyethylene glenoid and autologous bone graft obtained from the humeral head. This is a technically challenging method, requiring contouring of the graft and insertion of screws from posterior to anterior.

The average glenoid retroversion on preoperative computed tomography (CT) scans was 44° (range, 20° to 65°). Based on the Walch classification of pathologic glenoid morphology, nine glenoids were B2 and three were type C. 

The preoperative glenoid retroversion angle was measured on CT scan and averaged  44° ± 14° (range, 20° to 65°).  The postoperative postoperative retroversion was measured on axillary radiographs and averaged 21.3° ± 7.9° (range, 8° to 27.4°).

Two patients (17%) required revision surgery for failure of fixation and of graft incorporation (one of the two had positive cultures for Propionibacterium. Two additional patients had broken fixation screws.

We conclude that total shoulder arthroplasty for a retroverted, posteriorly eroded glenoid with posterior humeral subluxation remains a challenge because of the risk of glenoid component failure. For selected patients with this pathology, a ream and run may be a better option.

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