Glenoid structural bone grafting in reverse total shoulder arthroplasty: clinical and radiographic outcomes

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery Pub Date : 2025-02-01 DOI:10.1016/j.jse.2024.05.008

Connor Sholtis MD, Stephanie T. Kha MD, Anna Ramakrishnan MS, Geoffrey D. Abrams MD, Michael T. Freehill MD, Emilie V. Cheung MD

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引用次数: 0

Abstract

Background

Current options for reconstruction of large glenoid defects in reverse total shoulder arthroplasty (RTSA) include structural bone grafting, use of augmented components, or 3D-printed custom implants. Given the paucity in the literature on structural bone grafts in RTSA, this study reflects our experience on clinical and radiographic outcomes of structural bone grafts used for glenoid defects in RTSA.

Methods

We identified 33 consecutive patients who underwent RTSA using structural bone grafts for glenoid bone loss between 2008 and 2019. Twenty-six patients with a mean clinical follow-up of 4.4 ± 3.9 years and a mean radiographic follow-up of 2.7 ± 3.2 years were included. Patient demographic data, perioperative functional outcomes, radiographic outcomes, complications, and reoperation rates were determined.

Results

Between 2008 and 2019, 26 RTSAs were performed using structural autograft or allograft for glenoid defects. There were 20 females (77%) and 6 males (23%), with a mean presenting age of 68 years (range 41-86), mean BMI of 29 (range 21-44), and mean Charlson Comorbidity Index of 3 (range 0-8). There were 19 cases of central glenoid defects, and 7 were combined central and peripheral defects. Structural grafts included humeral head autograft (7), proximal humerus autograft (7), iliac crest autograft (7), distal clavicle autograft (2), and femoral head allograft (3). All 18 revision RTSA cases had simultaneous humeral-sided revision. There was significant postoperative improvement in American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form scores (27.0 ± 12.6 preoperation vs. 59.8 ± 24.1 postoperation; P < .001) and visual analog scale scores (8.1 ± 3.6 preoperation vs. 3.0 ± 3.2 postoperation; P < .001). Range of motion improved significantly for active forward elevation (63° ± 36° preoperation vs. 104° ± 36° postoperation; P < .001) and external rotation (21° ± 20° preoperation vs. 32° ± 23° postoperation, P = .036). Eighty-eight percent of cases (23 of 26) had successful reconstruction of the glenoid, defined as no visible radiolucent lines nor glenoid component migration at final follow-up. The reoperation rate was 19% (5 of 26). Postoperative complications included 2 cases of acromial stress fractures that were treated nonoperatively, for a total complication rate (including reoperation) of 27% (7 of 26 cases).

Conclusions

The use of structural bone autografts and allografts in RTSA was associated with improved outcome scores and range of motion. A reoperation rate of 19% and total complication rate of 27% were reported for these challenging cases. However, 86% of these complications were not related to structural glenoid reconstruction failure. Structural grafts are a reasonable option for glenoid reconstruction in RTSA cases with glenoid bone loss.

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反向全肩关节置换术中的盂状结构骨移植：临床和影像学结果

导言：在反向全肩关节置换术（RTSA）中，重建大面积盂缺损的现有方案包括结构性骨移植、使用增强组件或3D打印定制植入物。鉴于有关反向全肩关节置换术中结构性骨移植的文献较少，本研究反映了我们在反向全肩关节置换术中利用结构性骨移植治疗盂缺损的临床和影像学结果：我们确定了 33 名在 2008 年至 2019 年期间因盂骨缺损而接受 RTSA 并使用结构性植骨的连续患者。26例患者的平均临床随访时间为（4.4 ± 3.9）年，平均影像学随访时间为（2.7 ± 3.2）年。确定了患者的人口统计学数据、围手术期功能结果、放射学结果、并发症和再手术率：2008年至2019年期间，共进行了26例RTSAs手术，利用结构性自体或异体移植物治疗盂缺损。其中女性20例（77%），男性6例（23%），平均发病年龄68岁（41-86岁），平均体重指数29（21-44岁），平均Charlson综合指数3（0-8岁）。其中19例为中央型盂缺损，7例为中央型和外周型联合缺损。结构性移植物包括肱骨头自体移植物（7 例）、肱骨近端自体移植物（7 例）、髂嵴自体移植物（7 例）、锁骨远端自体移植物（2 例）和股骨头同种异体移植物（3 例）。所有18例RTSA翻修病例都同时进行了肱骨侧翻修。术后ASES评分有明显改善（术前27.0 ± 12.6 vs. 术后59.8 ± 24.1; p结论：在RTSA中使用结构性骨自体和异体移植与结果评分和活动范围的改善有关。据报道，在这些具有挑战性的病例中，再次手术率为 19%，总并发症率为 27%。然而，86%的并发症与结构性盂重建失败无关。对于盂骨缺失的 RTSA 病例，结构性移植物是盂骨重建的合理选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.