Glenoid bone grafting in reverse shoulder arthroplasty for long-standing anterior shoulder dislocation

Birgit S Werner; Dorota Böhm; Ayman Abdelkawi; Frank Gohlke

doi:10.1016/j.jse.2014.02.017

Glenoid bone grafting in reverse shoulder arthroplasty for long-standing anterior shoulder dislocation

J Shoulder Elbow Surg. 2014 Nov;23(11):1655-61. doi: 10.1016/j.jse.2014.02.017. Epub 2014 May 14.

Authors

Birgit S Werner¹, Dorota Böhm², Ayman Abdelkawi³, Frank Gohlke³

Affiliations

¹ Clinic for Orthopaedic and Trauma Surgery, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany; Department of Orthopaedic Surgery, University of Würzburg, Koenig-Ludwig-Haus, Würzburg, Germany. Electronic address: birgitwerner@hotmail.com.
² Department of Orthopaedic Surgery, University of Würzburg, Koenig-Ludwig-Haus, Würzburg, Germany.
³ Clinic for Shoulder and Elbow Surgery, Bad Neustadt/Saale, Germany.

PMID: 24835299
DOI: 10.1016/j.jse.2014.02.017

Abstract

Background: Long-standing anterior glenohumeral dislocation results in both humeral and glenoid bone loss, as well as concomitant soft tissue pathologies. Reverse shoulder arthroplasty (RSA) is an established procedure to restore both stability and function in cuff-deficient shoulders. However, fixation of the glenoid component is prone to failure in cases of advanced glenoid vault destruction and requires substantial bone graft. The purpose of this study was to evaluate the outcome of glenoid bone grafting in RSA for neglected anterior dislocation with significant glenoid bone loss.

Materials and methods: We reviewed 21 of 32 patients after 1-staged RSA and glenoid bone grafting with resected humeral head, with a mean follow-up period of 4.9 years (range, 2-10 years). The mean age at the time of surgery was 71 years (range, 50-85 years). Glenoid bone loss averaged 45% of glenoid width according to preoperative computed tomography or magnetic resonance imaging scans. A long-pegged glenoid baseplate was used in 9 patients.

Results: The mean Constant score improved from 5.7 points (range, 0-22 points) preoperatively to 57.2 points (range, 26-79 points) postoperatively (P < .001). Two patients required revision because of baseplate loosening: one patient underwent conversion to a hemiarthroplasty, and the other patient underwent a 2-staged reconstruction with tricortical iliac crest bone graft.

Conclusion: RSA in neglected anterior dislocation is a successful treatment option even in the case of advanced glenoid bone loss. To maintain stable fixation of the glenoid component, comprehensive preoperative analysis of the remaining bone stock based on 3-dimensional computed tomography scans should be included, with particular attention to ensure optimal anchorage length of the baseplate's central peg in the native glenoid bone stock.

Keywords: Reverse shoulder arthroplasty; anterior dislocation; glenoid bone grafting; glenoid defects.

MeSH terms

Aged
Aged, 80 and over
Arthroplasty, Replacement*
Bone Transplantation*
Female
Humans
Male
Middle Aged
Scapula / surgery*
Shoulder Dislocation / surgery*
Shoulder Joint / surgery*