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134 | www.shoulderelbowsurgery.com Techniques in Shoulder & Elbow Surgery Volume 15, Number 4, December 2014
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Techniques in Shoulder & Elbow Surgery Volume 15, Number 4, December 2014 Bone Graft Reverse Shoulder Arthroplasty
FIGURE 2. Axillary view showing advanced degenerative FIGURE 4. MRI image demonstrating fatty infiltration of the
change. rotator cuff muscles.
FIGURE 7. Preparing the glenoid with drilling for central FIGURE 10. Placing bone graft on baseplate in correct
peg. rotation.
DISCUSSION
Glenoid bone loss poses a significant problem for patients
requiring a reverse total shoulder arthroplasty. Adequate gle-
noid bone stock is critical for minimizing the likelihood of
glenoid component loosening and failure, and has received
considerable attention in the setting of the total shoulder
arthroplasty. Neer and Morrison7 reported the use of humeral
head corticocancellous graft in 20/463 total shoulder arthro-
plasties with glenoid defects secondary to a multitude of eti-
ologies. The Mayo group recently reported on the results of
structural humeral head autografting, with a mean of 8.7-year
follow-up, inclusive of their preliminary data from 13 years
prior. Although clinical outcomes were favorable, the authors
recognized the technique’s limitations and note worrisome
radiographic deterioration of the glenoid fixation.8,10
FIGURE 13. Postoperative scapula lateral radiograph view.
glenoid baseplate positioning being too superior in cases of 5. Kelly JD II, Humphrey CS, Norris TR. Optimizing glenosphere
superior glenoid deficiency, potentially leading to impinge- position and fixation in reverse shoulder arthroplasty, part one: the
ment. Neyton et al15 used either humeral head or iliac crest twelve-mm rule. J Shoulder Elbow Surg. 2008;17:589–594.
corticocancellous autograft in 9 patients, with their cohort 6. Harman M, Frankle M, Vasey M, et al. Initial glenoid component
encompassing both primary and revision patients cases. At a fixation in “reverse” total shoulder arthroplasty: a biomechanical
mean of 31 months, they observed no radiographic evidence of evaluation. J Shoulder Elbow Surg. 2005;14:S162–S167.
component loosening, graft lysis, or graft compression. 7. Neer CS, Morrison DS. Glenoid bone-grafting in total shoulder
Bateman and Donald16 reported on a novel technique that arthroplasty. J Bone Joint Surg Am. 1988;70-A:1154–1162.
addresses glenoid deficiency using a hybrid corticocancellous
8. Steinmann SP, Cofield RH. Bone grafting for glenoid deficiency
graft, with a femoral neck allograft acting as a cortical bushing
in total shoulder replacement. J Shoulder Elbow Surg. 2000;9:
to prevent medialization, filled with impacted cancellous 361–367.
autograft. Klein et al17 demonstrated that comparable short-
term clinical outcomes can be achieved in the setting of gle- 9. Hill JM, Norris TR. Long-term results of total shoulder arthroplasty
following bone-grafting of the glenoid. J Bone Joint Surg Am.
noid bone loss when surgical technique is altered, with
2001;83:877–883.
reported methods including the adjustment of glenosphere size
or bone grafting. 10. Klika BJ, Wooten CWW, Sperling JW, et al. Structural bone grafting
Our technique addresses the problem of restoring glenoid for glenoid deficiency in primary total shoulder arthroplasty.
version with an autograft from the humeral head. This provides J Shoulder Elbow Surg. 2013;23:1066–1072.
an excellent source of bone stock, and the curvature of the 11. Antuna SA, Sperling JW, Cofield RH, et al. Glenoid revision surgery
humeral head contours naturally as a graft. There is no donor-site after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001;10:
morbidity of iliac crest, and there are not any of the risks 217–224.
involved with allograft. We have appreciated integration of the 12. Antuna S, Sperling JW, Cofield RH. Reimplantation of a glenoid
graft with the glenoid, and our experience has shown excellent component after component removal and allograft bone grafting: a
results with this technique. We recommend this to address report of 3 cases. J Shoulder Elbow Surg. 2002;11:637–641.
excessive glenoid version in reverse total shoulder arthroplasty. 13. Cheung EV, Sperling JW, Cofield RH. Reimplantation of a glenoid
component following component removal and allogenic bone-grafting.
J Bone Joint Surg Am. 2007;89:1777–1783.
14. Sirveaux F, Favard L, Oudet D, et al. Grammont inverted total
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