Bone grafting in oblique versus prepared rectangular uncontained glenoid defects in reversed shoulder arthroplasty. A biomechanical comparison

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

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CT evaluation of glenoid joint line restoration with glenoid bone grafting and reverse shoulder arthroplasty in patients with significant glenoid bone loss

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.09.031 ◽

2020 ◽

Author(s):

Kristine R. Italia ◽

Nicholas Green ◽

Jashint Maharaj ◽

Marine Launay ◽

Ashish Gupta

Keyword(s):

Bone Loss ◽

Shoulder Arthroplasty ◽

Bone Grafting ◽

Reverse Shoulder Arthroplasty ◽

Joint Line ◽

Glenoid Bone Loss ◽

Ct Evaluation

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Preoperative three-dimensional computer planning for reverse total shoulder arthroplasty and bone grafting for severe glenoid deformity

Shoulder & Elbow ◽

10.1177/1758573220908903 ◽

2020 ◽

pp. 175857322090890

Author(s):

Robert Z Tashjian ◽

Lindsay Beck ◽

Irene Stertz ◽

Peter N Chalmers

Keyword(s):

Shoulder Arthroplasty ◽

Bone Grafting ◽

Total Shoulder Arthroplasty ◽

Three Dimensional ◽

Reverse Total Shoulder Arthroplasty ◽

Patient Specific ◽

Computer Assisted ◽

Patient Specific Instrumentation ◽

Reverse Total Shoulder ◽

Glenoid Erosion

Background Computer assisted planning without patient specific instrumentation may be utilized to guide reverse total shoulder arthroplasty baseplate placement. The purpose of this study was to determine the difference between planned and achieved inclination and retroversion correction with three-dimensional preoperative computer assisted planning in reverse total shoulder arthroplasty without patient specific instrumentation with bone grafting for severe glenoid erosion. Methods Preoperative three-dimensional computer assisted planning without patient specific instrumentation was performed on 15 patients undergoing primary reverse total shoulder arthroplasty with glenoid bone grafting for severe glenoid erosion. On preoperative and immediate postoperative computed tomography slices, two-dimensional retroversion and inclination were measured. Preoperative three-dimensional baseline retroversion and inclination and planned postoperative three-dimensional retroversion and inclination were measured. Planned and achieved version and inclination changes were compared. Results The planned and achieved retroversion corrections were 18° and 12°, respectively (p < 0.001). The planned and achieved inclination corrections were 11° and 11°, respectively (p = 0.803). Conclusions Three-dimensional computer assisted planning without patient specific instrumentation in the setting of reverse total shoulder arthroplasty with severe glenoid erosion requiring bone grafting can accurately guide baseplate placement. All cases in which failure to correct retroversion or inclination within 10° of planning occurred in patients with severe erosion (B3 or E3 glenoids), therefore patient specific guides may be warranted in these cases to improve accuracy of implantation. Level of evidence Level IV, retrospective case series.

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