Improved patient outcomes and range of motion following primary and revision reverse total shoulder arthroplasty utilizing a custom glenoid implant for glenoid deficiency

Abstract

Background

Glenoid bone loss in the primary and revision setting of reverse total shoulder arthroplasty (rTSA) creates the challenge of sufficient glenoid component positioning and fixation and is at risk of early mechanical failure and aseptic baseplate loosening. The purpose of this study was to evaluate clinical outcomes of primary and revision rTSA utilizing a custom glenoid implant for treatment of glenoid bone deficiency.

Methods

Patients who underwent rTSA with a Comprehensive Vault Reconstruction System (VRS) (Zimmer Biomet, Warsaw, IN, USA) custom glenoid implant in the primary or revision setting performed by 2 orthopedic surgeons between April 2016 and October 2023 were included. Demographic, prior surgical history, preoperative assessment, radiographic parameters, intraoperative procedures, and complication data were collected. Preoperative and postoperative range of motion and Single Assessment Numeric Evaluation (SANE) scores were compared and minimal clinically important difference was calculated for shoulder forward flexion (aFF), shoulder external rotation (aER), and SANE scores.

Results

Fifty-two shoulders (50 patients) met the inclusion criteria with 49 shoulders (47 patients) (94%) completing follow-up at mean 15.3 ± 21.0 months (range: 3-91 months). Mean age was 67 ± 13 with 25 females (51%). There were 16 (33%) primary and 33 (67%) revision rTSAs. There was significant improvement from preoperative to postoperative aFF (n = 45, 79 ± 35 to 118 ± 36, P < .001), aER (n = 42, 18 ± 24 to 29 ± 21, P = .02), and SANE score (n = 34, 32 ± 22 to 69 ± 23, P < .001). Minimal clinically important difference was calculated to be 69% for aFF, 67% for aER, and 79% for SANE. Two shoulders (4%) required revision surgery.

Conclusion

At mean follow-up of 15.3 months, rTSA with VRS custom glenoid implants for the treatment of glenoid bone deficiency in the primary and revision setting demonstrated improved patient-reported-outcomes and range of motion with low complication rate.