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“Shaped” humeral head autograft reverse shoulder arthroplasty

Treatment for primary glenohumeral osteoarthritis with significant posterior glenoid bone loss (B2, B3, and C type)

Inverse Schulterendoprothese mit individuellem autologem Glenoidaufbau

Therapie für primäre Omarthrose mit deutlichem posteriorem Glenoiddefekt (Typ B2, B3 und C)

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Abstract

Background

Posterior glenoid bone loss in primary glenohumeral osteoarthritis (GHOA) presents a challenge when considering replacement surgery. Results with anatomic shoulder arthroplasty are unpredictable due to posterior humeral instability and limited bone stock for glenoid component fixation.

Objectives

To describe and evaluate the results of a “shaped” humeral head autograft with reverse shoulder arthroplasty (RSA) for the treatment of primary GHOA with significant posterior glenoid bone loss and an intact, functional rotator cuff.

Materials and methods

We retrospectively reviewed 29 “shaped” humeral head autografts with RSA for the treatment of GHOA with B2 (n = 16), B3 (n = 10), or C (n = 3) glenoid morphology based on the Walch classification system. Average glenoid retroversion was 32.3°. Humeral head autografts were “shaped” to match each patient’s individual glenoid morphology. Functional outcome scores, range of motion, strength, and radiographic outcomes were evaluated.

Results

At average follow-up of 34.6 months (range 23.7–88.9 months), significant improvements were seen in all functional outcome scores, ranges of motion, and strength (p <0.01). No recurrent instability or glenoid fixation failure occurred. Two complications (1 superficial and 1 deep infection) in 2 patients were identified. All autografts incorporated without radiographic evidence of loosening. Scapular notching was observed in 8 shoulders. No negative correlations were identified with glenoid morphology.

Conclusions

“Shaped” humeral head autograft with RSA for the treatment of primary GHOA with significant posterior glenoid bone loss is associated with excellent clinical and radiographic outcomes and a low complication profile at short- to mid-term follow-up.

Zusammenfassung

Hintergrund

Posteriore Glenoiddefekte bei der primären Omarthrose stellen für die endoprothetische Versorgung eine Herausforderung dar. Die Ergebnisse sind mit anatomischen Endoprothesen wegen der Dezentrierung und oft grenzwertigen Möglichkeit der Fixierung einer Glenoidkomponente nicht vorhersagbar.

Ziel der Arbeit

Operationstechnik und mittelfristige Ergebnisse nach operativer Behandlung einer Omarthrose mit signifikantem Knochendefekt bei intakter Rotatorenmanschette mittels inverser Schultertotalendoprothese (TEP) und autologem Glenoidaufbau werden beschrieben.

Material und Methoden

Es wurden 29 Fälle nach Implantation einer inversen TEP und Glenoidaufbau mittels individuell angepasstem autologem Knochenblock retrospektiv ausgewertet, davon 16 Fälle mit B2-, 10 mit B3-Deformität und 3 mit einem C‑Typ nach Walch-Klassifikation. Die durchschnittlich gemessene Retroversion betrug 32,3°. Die autologen Knochenblöcke wurden an die individuelle Glenoidmorphologie angepasst. Funktionelles Ergebnis, Bewegungsumfang, Kraft und Röntgenbefund wurden erhoben.

Ergebnisse

Nach durchschnittlich 34,6 Monaten (23,7–88,9 Monate) fand sich eine signifikante (p < 0,01) Verbesserung in allen erhobenen Parametern (Bewegungsumfang, Kraft und Score). Weder eine Instabilität noch eine Lockerung wurden festgestellt. Zwei Komplikationen (eine oberflächliche und eine tiefe Infektion) traten auf. Bei allen autologen Transplantaten lag röntgenologisch ein Einbau ohne Anhalt für eine Lockerung der Basisplatte vor. Ein Skapula-Notching zeigte sich in 8 Fällen. Es ließ sich keine Korrelation des klinischen Ergebnisses mit der Schwere des Glenoiddefekts bzw. der präoperativ vorhandenen Morphologie herstellen.

Schlussfolgerung

Mit individuell angepasstem autologem Glenoidaufbau und inverser TEP können kurz- bis mittelfristig auch in Fällen mit ausgeprägtem Knochendefekt bei Omarthrose ausgezeichnete klinische und radiologische Ergebnisse bei niedriger Komplikationsrate erzielt werden.

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Abbreviations

ABD:

Abduction

AROM:

Active range of motion

ASES:

American Shoulder and Elbow Surgeons

BIORSA:

Bony increased offset reverse shoulder arthroplasty

CT:

Computed tomography

ER:

External rotation with the arm held at 0° of abduction

FF:

Forward flexion

FOS:

Functional outcome scores

GHOA:

Glenohumeral osteoarthritis

IR:

Internal rotation

IRB:

Institutional review board

PGBL:

Posterior glenoid bone loss

RSA:

Reverse shoulder arthroplasty

SANE:

Simple Assessment Numeric Evaluation

TSA:

Total shoulder arthroplasty

VAS:

Visual analog scale

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Funding

Funding used for management of the database was provided by Tornier, Inc. User Friendly Custom Software, Inc., the hosting company of the database, was paid an annual fee directly from Tornier, Inc. No other funding was received for this study.

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Authors and Affiliations

  1. The Orthopedic Clinic Association, 2222 E Highland Ave #300, 85016, Phoenix, AZ, USA

    S. Harmsen MD

  2. The San Francisco Shoulder, Elbow, and Hand Clinic, San Francisco, CA, USA

    D. Casagrande MD & T. Norris MD

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  1. S. Harmsen MD
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  2. D. Casagrande MD
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  3. T. Norris MD
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Correspondence to S. Harmsen MD.

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Conflict of interest

S. Harmsen, D. Casagrande, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article and declare that they have no competing interests. T. Norris received royalties and consultant payments from Tornier, Inc., which is related to the subject of this work. Dr. Norris also received financial support from Tornier, Inc. for the database used in the study.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

Institutional Review Board approval for this study was provided by the California Pacific Medical Research Institute, study number 27.007.

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Harmsen, S., Casagrande, D. & Norris, T. “Shaped” humeral head autograft reverse shoulder arthroplasty. Orthopäde 46, 1045–1054 (2017). https://doi.org/10.1007/s00132-017-3497-0

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