Wednesday, January 17, 2018

Reverse total shoulder in the face of glenoid defects

Management of glenoid bone defects with reverse shoulder arthroplasty—surgical technique and clinical outcomes

Between 2001 and 2010, these authors found that 94 of 1074 reverse total shoulders had significant glenoid bone loss. Of these patients, 17% had a centric defect 

 and 83% had an eccentric glenoid defect.

Composite glenoid grafts were required in 12 patients, 9 of whom required a glenoid baseplate with a long central peg.

92.5% (87/94) of the patients could be managed with a single-stage procedure.  If the long central peg did not purchase a minimum of 50% of its length in the native scapula, a single-stage reconstruction was aborted in favor of a 2-stage procedure: the glenoid defect was grafted with a composite graft and fixated using cortical screws as required to attain graft stability. In cases of centric defects, a modular humeral component was used and a hemiarthroplasty performed. In cases in which eccentric defects were reconstructed, a resection arthroplasty was performed. In the authors’ experience, a hemiarthroplasty for an eccentric bone defect led to poor graft incorporation and graft nonunion or resorption.

Comment: The key in such cases is that secure baseplate fixation needs to be achieved before the construct is loaded by completing the reverse total shoulder with a glenosphere and a humeral component.

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