Wednesday, January 3, 2018

Reverse total shoulder - use of bone graft for glenoid deficiency

Bone Graft Augmentation for Severe Glenoid Bone Loss in Primary Reverse Total Shoulder Arthroplasty Outcomes and Evaluation of Host Bone Contact by 2D-3D Image Registration

These authors reviewed the outcomes for 57 patients who were treated with a primary RSA and glenoid bone-grafting for severe glenoid bone loss.

The decision to use a structural bone graft was determined intraoperatively when 80% baseplate to bone host bone contact could not be achieved.

At a mean of 46 months (minimum, 24 months), the patients demonstrated significant improvements in function, motion, and pain. On the basis of the generated 3D model, the baseplate contact to host bone was only 17% ± 12% (range, 0% to 50%). There was no significant correlation between host bone coverage and change in the ASES score (p = 0.51) for the 44 patients included in this analysis. There were 4 major complications (7%) in the study group but no glenoid baseplate failures.

There were 4 major complications (7%) in the study group, and none of them involved glenoid baseplate failure. One baseplate demonstrated radiolucent lines concerning for loosening; however, the patient did not show signs of clinical failure and therefore did not undergo revision surgery. Complications required revision surgery in 3 patients. Two shoulders underwent a single-stage revision to a long-stemmed implant for humeral loosening, and 1 was treated with open reduction and internal fixation for a periprosthetic fracture. There were 5 acromial or scapular spine fractures (9%) noted in the study group. Four patients (7%) demonstrated scapular notching.
Comment: This article points to the importance of structural support from humeral head autograft or femoral head allograft in managing glenoid bone deficiency when performing a reverse total shoulder. The authors point to the utility of a hooded component to help contain the graft.

The security of bone graft fixation depends on solid bites in the host bone with the screw fixation system

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