Structural bone grafting for glenoid bone loss in primary anatomic total shoulder arthroplasty: a case series and technique report

Abstract

Background: Posterior glenoid bone loss in glenohumeral osteoarthritis poses significant challenges in shoulder arthroplasty. Anatomic total shoulder arthroplasty (TSA) with a humeral head autograft to address the glenoid bone deficiency is an option for these difficult cases. Variable results with this procedure are reported in the literature. This article describes the surgical technique of posterior glenoid bone grafting in TSA using a glenoid implant with hybrid fixation and a series of reported patient functional and radiographic outcomes. Methods: A retrospective chart review of cases from 2015 to 2020 by a single surgeon revealed 10 patients who underwent primary TSA with hybrid glenoid component and posterior glenoid bone grafting. Preoperative and postoperative radiographs were assessed for glenoid inclination, glenoid version, acromiohumeral distance, humeral stem status, and glenoid implant status. Functional outcomes were evaluated by range of motion, strength, and patient-reported clinical outcomes (pain and function on a visual analog scale, Disabilities of the Arm, Shoulder, and Hand score, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons score). Complications and reoperations were also evaluated. Results: Average follow-up was 31.4 months, active forward flexion and external rotation improved on average from 105° to 150° and 20° to 60°, respectively (P < .001) and average abduction improved from 100° to 140° (P < .002). At an average of 26.7 months, patients reported assessments (visual analog scale pain and function, Disabilities of the Arm, Shoulder, and Hand score, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons scores) reveal significant (P < .05) improvement in pain and functional outcomes. Radiographically, at 23.0 ± 20.1 months, all patients demonstrated a well-fixed humeral and glenoid component without evidence of lucent lines. The bone graft used in each patient was well unionized and no radiographic complications were reported. No patients underwent revision surgery, and there was one clinical complication reported, which consisted of a suspected rotator cuff injury at follow-up. Conclusion: Hybrid fixation with structural glenoid bone grafting in TSA resulted in excellent outcomes with no evidence of graft or component failure on follow-up radiographs and significantly reduced pain, improved functional scores, and improved active range of motion.

Keywords

• Total shoulder arthroplasty
• Posterior glenoid bone loss
• Posterior glenoid bone graft
• Humeral head autograft
• Hybrid fixation
• Cemented fixation