Friday, December 20, 2013

Revision shoulder arthroplasty with glenoid bone graft reconstruction

Outcomes after shoulder arthroplasty revision with glenoid reconstruction and bone grafting.

These authors report 17 patients who underwent reconstruction surgery for massive glenoid bone loss after a prior total shoulder using an autologous iliac crest bone graft and secondary revision arthroplasty.

Constant scores improved from 24 ± 17 and to 40 ± 13. CT scans revealed adequate glenoid bone stock restoration with no relevant graft resorption or loosening of the glenoid.

This is a complex two-stage procedure. In the first step the humeral component was revised and the glenoid component removed. A tricortical bone graft from the ipsilateral iliac crest, contoured and fixed to the native glenoid by cannulated 2.7-mm titanium screws. Three months later a second surgery was performed at which the screws were removed and a cemented keeled polyethylene glenoid component inserted.

Comment: These authors have demonstrated a possible approach to the failed glenoid component with bone loss: a two stage graft reconstruction.

Because of concern regarding the possibility of infection associated with glenoid component failure and the poor quality of residual bone at the time of revision, we usually remove the glenoid component, avoid grafting of any type and revise the humeral component to articulate with the residual glenoid bone as shown here, here and here. This is a single stage approach that avoids the risk of a second glenoid component failure.


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