Thursday, December 26, 2013

Does bone grafting solve the problem of glenoid bone deficiency?

Structural bone grafting for glenoid deficiency in primary total shoulder arthroplasty.

These authors reviewed 25 shoulders (representing about 1% of the total number of primary total arthroplasties they performed over the same time period) having a structural bone graft (humeral head autograft and screw fixation) as a glenoid bone augmentation prior to glenoid component placement. Mean clinical and radiographic followup were about 8 years.

On radiographic evaluation, 10 shoulders had glenoids at risk for component loosening. Two of these shoulders were symptomatic and underwent revision surgery to address glenoid component loosening.

Although most of the patients were clinically improved, this study points to the challenges of total shoulder arthroplasty in the management of a retroverted glenoid with posterior humeral instability. The large forces on the back of the glenoid threaten fixation of the graft and the component.

We have used the ream and run procedure for carefully selected patients with this type of glenohumeral pathoanatomy, avoiding the risk of glenoid component failure in the bad arthritic triad (BAT).


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