Thursday, November 3, 2016

Reverse total shoulder for arthritic shoulders with glenoid bone loss

Reverse Total Shoulder Arthroplasty without Bone-Grafting for Severe Glenoid Bone Loss in Patients with Osteoarthritis and Intact Rotator Cuff

These authors reviewed 42 patients (23 women; mean age, 71 years [range, 53 to 89 years]) with primary glenohumeral osteoarthritis, intact rotator cuffs, and Walch type-A2 (n = 19), B2 (n = 5), or C glenoids (n = 18) who had a reverse total shoulder with glenoid reaming without bone-grafting at a mean followup of 36 months (the authors refer to this as an “off-label” indication for this device).

One baseplate (2%) failed, requiring revision surgery.
Eight (19%) of the patients had notching.

On average, patients were improved with respect to pain and function.

Here is an example provided by the authors.

Comment: Cases of arthritis with intact cuffs can usually be well managed by conventional anatomic arthroplasty. If the glenoid bone is insufficient for a glenoid component, a hemiarthroplasty usually provides a safe approach to improving comfort and function if there is concern about glenoid penetration with the pegs of a glenoid component. Note as shown in the case above, glenoid penetration can be observed with the reverse as well. As the authors point out, glenoid insufficiency increases the risk of baseplate failure in reverse total shoulder arthroplasty.


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