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Erschienen in:
30.10.2017 | Originalien
“Shaped” humeral head autograft reverse shoulder arthroplasty
Treatment for primary glenohumeral osteoarthritis with significant posterior glenoid bone loss (B2, B3, and C type)
Erschienen in: Die Orthopädie | Ausgabe 12/2017
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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.