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Lo EY, Nazemi M, Ouseph A, Edwards AS, Weingast N, Krishnan SG. Short-Term Radiographic Outcomes of Bone Versus Metallic Augmented, Central Screw Type Baseplate in Reverse Total Shoulder Arthroplasty: Matched Case-Control Study. J Shoulder Elb Arthroplast 2024; 8:24715492241259470. [PMID: 38846321 PMCID: PMC11155345 DOI: 10.1177/24715492241259470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
Background Although glenoid bone grafting and metallic augmented baseplates have demonstrated success in restoring the glenohumeral joint line in the recent literature, there remain no consensus guidelines defining the use of one versus the other. Methods Between 2017 and 2020, 15 primary RTSA with screw-in metallically augmented glenoid baseplates were identified and 2:1 matched by age, sex, and body mass index with primary bony-augmented glenoid baseplate patients. Patients with previous glenoid implantation or fracture were excluded. Charts, routine radiographic series (Grashey, Scapula Y, Axillary lateral), and 3-dimensional computed tomography (3D CT) scans were retrospectively reviewed. Structural patient-specific metal or bony augmentation was indicated based on preoperative glenoid morphology as identified by 3D CT. Aseptic failure was identified as hardware breakage and/or shift in glenoid baseplate component position. Results There were 45 eligible cases with mean age of 65.7 years (range 44-85 years) and 65.5 years (range 42-82 years) for the metallic-augmented and bone graft group, respectively. Correspondingly, mean follow up was 22.6 months (range 12-53 months), and 27.3 months (range 11-53 months). At latest follow up, there were no baseplate failures in the metallic augment group and 2 baseplate failures (7%) in the bone graft group at a mean of 42.5 months (range 32-53 months) postoperatively. Mean age of the bone failure group was 64.5 years (range 64-65 years). Conclusion Contemporary reversed shoulder arthroplasty glenoid baseplate designs appear to have low incidence of failure. Further analysis is necessary to determine if a critical degree of glenoid retroversion or inclination is preferable with a specific form of augmentation. Level of Evidence III; Retrospective Cohort Comparison.
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Affiliation(s)
- Eddie Y Lo
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Monia Nazemi
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- University of North Texas Health Science Center, Ft. Worth, TX, USA
| | - Alvin Ouseph
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | | | - Nancy Weingast
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Sumant G Krishnan
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
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Franceschi F, Giovannetti de Sanctis E, Cristalli E. Shaping the bone autograft for reverse total shoulder arthroplasty without the use of any specific instrumentation. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:222-227. [PMID: 38706668 PMCID: PMC11065747 DOI: 10.1016/j.xrrt.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Francesco Franceschi
- UniCamillus-Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | | | - Edoardo Cristalli
- UniCamillus-Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Rome, Italy
- AOU Sant'Andrea, La Sapienza University of Rome, Rome, Italy
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Krupp R, O'Grady C, Werner B, Wiater JM, Nyland J, Duquin T. A two-year comparison of reverse total shoulder arthroplasty mini-humeral tray and augmented mini-glenoid baseplate implants vs. standard implants. Arch Orthop Trauma Surg 2024; 144:1925-1935. [PMID: 38523239 DOI: 10.1007/s00402-024-05276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Patients who undergo reverse total shoulder arthroplasty (RTSA) are getting younger with greater function expectations. This retrospective, longitudinal study of prospectively collected data compared perceived shoulder function and strength, active shoulder mobility, radiographic evidence of scapular notching, and implant survival over the initial 2-years post-RTSA among patient groups who received either standard central fixation point liner and glenoid baseplate implants, or lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants. MATERIALS AND METHODS Patients who underwent primary RTSA using standard central fixation point liner and glenoid baseplate implants (Group 1, n = 180) were compared with patients who underwent primary RTSA using lower size profile mini-humeral tray with offset trunnion options and mini-augmented glenoid baseplate implants (Group 2, n = 53) for active shoulder mobility, American Shoulder and Elbow Surgeons (ASES) score, perceived ability to lift 10 lbs (4.5 kg) overhead, radiographic evidence of scapular notching, and implant survival. Data was collected pre-surgery, 6-weeks, 6-months, 1-year, and 2-years post-RTSA (p ≤ 0.05). RESULTS More Group 2 patients had more complex B or C Walch glenoid morphology, while Group 1 had more A1 or A2 types (p ≤ 0.001). Group 2 had greater active shoulder flexion at 6-months, 1-year, and 2-years (p ≤ 0.018) and external rotation (in adduction) at 6-months and 2-years (p ≤ 0.004) compared to Group 1, with higher ASES scores at 6-months and 2-years (p ≤ 0.026) (with small-to-medium effect sizes), and with more patients meeting or exceeding the minimal clinically important difference (MCID) at 2-years (p = 0.045) and patient acceptable symptomatic state (PASS) levels at 6-months, 1-year and 2-years (p ≤ 0.045). Scapular notching was identified in six of 53 (11.3%) Group 2 patients and in 32 of 180 (17.7%) Group 1 patients. Group 1 patients had more grade 2 or greater scapular notching grades compared to Group 2 (p = 0.04). Implant survival was comparable with Group 1 = eight of 180 (4.4%) and Group 2 = 1 of 53 (1.9%) of patients requiring removal for 95.6% and 98.1% implant survival, respectively. CONCLUSION Limited scapular notching and excellent implant survival was observed in both groups. Despite including individuals with more complex glenoid deficiency, patients receiving the lower size profile implants generally displayed better active shoulder mobility and perceived shoulder function compared to those who received standard implants. These patients also more frequently met or exceeded the MCID by 2-years post-RTSA and PASS levels by 6-months, 1-year, and 2-years post-RTSA, with lower scapular notching grades. LEVEL OF EVIDENCE Retrospective comparative study.
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Affiliation(s)
- Ryan Krupp
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA
| | | | - Brian Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - J Michael Wiater
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - John Nyland
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA.
| | - Thomas Duquin
- Department of Orthopaedics, State University of New York at Buffalo, Buffalo, NY, USA
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Nezwek TA, Dutcher L, Lo EY, Ouseph A, Lund J, Krishnan SG. Yoke procedure as a salvage treatment option for failed reverse total shoulder arthroplasty with irreconstructible glenoid. J Shoulder Elbow Surg 2024; 33:335-342. [PMID: 37482247 DOI: 10.1016/j.jse.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Glenoid bone loss is a known challenge in primary and revision reverse total shoulder arthroplasty. In severe deficiency, even placing the baseplate in alternative centerline or using an augmented baseplate may be insufficient. This study reports on the use of a soft tissue resurfacing technique using Achilles tendon allograft, coined Yoke procedure, for salvage treatment of glenoid deficient shoulder requiring reconstruction. MATERIALS AND METHODS All patients who underwent the Yoke procedure between 2014 and 2020 by a single surgeon at a single academic center were identified and had their charts retrospectively reviewed. Demographics and surgical information were recorded. Preoperative X-rays and 3D-computed tomography scans were reviewed to classify patient glenoid types, evaluate glenoid medialization, and measure shoulder angles. Preoperative and postoperative range of motions and patient-reported outcome scores were evaluated, including anterior elevation, external rotation, internal rotation, visual analog scale, subjective shoulder value score, Simple Shoulder Test, and American Shoulder and Elbow Surgeons (ASES) scores. Postoperative radiographs and follow-up notes were reviewed to evaluate postoperative complication profiles at 1 year. RESULTS Seven patients with a median age of 69 years (range, 54-77 years) underwent Yoke procedure and had a median 12-month follow-up (range, 9-56 months). All patients were female and had a median of 2 prior shoulder surgeries (range, 0-13). Of all the patients, the most common comorbidity was osteoporosis (6) followed by rheumatoid arthritis (3). Of the 5 patients who had previous arthroplasty, the most common indications were baseplate failure (4), followed by instability (3) and infection (3). The median visual analog scale score improved from 8 (range, 3-9) to 2 (range, 1-4). The median Simple Shoulder Test improved from 8% (range, 0%-42%) to 33% (range, 17%-83%). The median ASES score improved from 15 (range, 5-38) to 52 (range, 40-78). The median anterior elevation and external rotation improved from 20° (range, 0°-75°) to 100° (range, 40°-145°) and 10° (range, 0°-20°) to 20° (range, 0°-55°), respectively. There was no change in median internal rotation. As of the last follow-up, one patient reported postoperative complications of anterior-superior implant escape, heterotopic ossification, and scapular notching. CONCLUSION The Yoke procedure is a promising salvage treatment that can offer patients consistent pain reduction and moderate functional improvements at short-term follow-up. In the setting of poor bone quality and severe glenoid deficiency, glenoid baseplate implantation may not be absolutely necessary for a pain-relieving, functionally acceptable outcome.
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Affiliation(s)
- Teron A Nezwek
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Lincoln Dutcher
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Eddie Y Lo
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA.
| | - Alvin Ouseph
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Julia Lund
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Sumant G Krishnan
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
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5
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Krupp R, O'Grady C, Werner B, Wiater JM, Nyland J, Duquin T. Mini-augmented glenoid baseplate and mini-humeral tray reverse total shoulder arthroplasty implant comparisons: two-year clinical outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1045-1056. [PMID: 37898968 DOI: 10.1007/s00590-023-03757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Augmented glenoid baseplate and offset humeral tray reverse total shoulder arthroplasty (RTSA) implants may decrease the mechanical impingement that creates scapular notching and improve shoulder function. This study evaluated the clinical efficacy of three different RTSA glenoid baseplate and offset humeral tray combinations for patient-reported shoulder function, pain and instability, radiographic imaging evidence of glenoid baseplate or humeral stem subsidence and migration, bony changes associated with implant loosening, and scapular notching over the initial 2 years post-RTSA. Primary outcomes included active shoulder mobility, perceived function, pain, instability, scapular notching, and implant survival. METHODS Sixty-seven patients from 6 research sites received one of three different glenoid baseplate and humeral tray combinations. Group 1 (n = 21) received a mini-augmented glenoid baseplate with a standard humeral tray; Group 2 (n = 23) received a standard glenoid baseplate and a mini-humeral tray with 3 trunnion offset options; Group 3 (n = 23) received both a mini-augmented glenoid baseplate and a mini-humeral tray with 3 trunnion offset options. Subjects underwent radiologic evaluation, completed the ASES scale, the EQ-5D-5L quality of life scale, VAS shoulder pain and instability questions, and active shoulder mobility measurements pre-operatively, and 6-weeks, 6-months, 1-2 years post-RTSA. RESULTS Improved active shoulder mobility, quality of life, perceived function, decreased shoulder pain and instability, excellent implant survival and minimal scapular notching were observed for all groups. Group 3 had better overall active shoulder mobility than the other groups and better perceived function than Group 1. CONCLUSION The group that received the mini-augmented glenoid baseplate and mini-humeral tray combination had better overall active shoulder flexion, external rotation at 90° abduction, and internal rotation. This group also had better perceived shoulder function compared to the group that received a mini-augmented glenoid baseplate with a standard humeral tray.
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Affiliation(s)
- Ryan Krupp
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA
| | | | - Brian Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - J Michael Wiater
- Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, , Royal Oak, MI, USA
| | - John Nyland
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA.
| | - Thomas Duquin
- Department of Orthopaedics, State University of New York at Buffalo, Buffalo, NY, USA
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Al-Omairi S, Albadran A, Dagher D, Leroux T, Khan M. Glenoid bone loss in shoulder arthroplasty: a narrative review. ANNALS OF JOINT 2024; 9:8. [PMID: 38529296 PMCID: PMC10929280 DOI: 10.21037/aoj-23-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/04/2023] [Indexed: 03/27/2024]
Abstract
Background and Objective Crucial to the success of any total or reverse shoulder arthroplasty (RSA) is the stability of the glenoid component fixation. Instability can lead to early implant failure and unsatisfactory results. Patients often present with varying forms of glenoid bone loss (GBL) in both the primary and revision settings, which can be a challenge for the treating surgeon. Severe cases of GBL can increase the risk of potential complications and diminish implant longevity. The use of the reverse total shoulder replacement has been particularly helpful when addressing significant glenoid bony defects. Various approaches have been proposed to deal with GBL, all of which require an individualized assessment of the specifics of the defect in order to provide maximal fixation and thereby optimize the longevity of the shoulder arthroplasty. This article aims to review the recent literature on GBL in shoulder arthroplasty to provide guidance when considering treatment based on the best available evidence. Methods PubMed, MEDLINE, EMBASE, AccessMedicine, ClinicalKey, DynaMed, and Micromedex were queried for publications utilizing the following keywords: "glenoid bone loss" AND "glenoid bone deficiency" AND "shoulder arthroplasty" AND "classification". The search was restricted to research published between 2004 and 2023. There were no restrictions on study type or language. Key Content and Findings GBL should be critically evaluated prior to undertaking total shoulder arthroplasty (TSA). The treating surgeon should be aware of various methods of addressing bone defects. Conclusions The use of TSA is increasing to address various shoulder pathologies. Addressing glenoid bone defects is of critical importance to maximize the longevity and outcome of TSA.
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Affiliation(s)
- Sultan Al-Omairi
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- Orthopedic Surgery Department, Sohar hospital, Sohar, Oman
| | - Adeeba Albadran
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- Section of Orthopaedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital (KAAUH), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Danielle Dagher
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Apiwatanakul P, Meshram P, Harris AB, Bervell J, Łukasiewicz P, Maxson R, Best MJ, McFarland EG. Use of custom glenoid components for reverse total shoulder arthroplasty. Clin Shoulder Elb 2023; 26:343-350. [PMID: 37957883 DOI: 10.5397/cise.2023.00563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/02/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Our purpose was to evaluate a custom reverse total shoulder arthroplasty glenoid baseplate for severe glenoid deficiency, emphasizing the challenges with this approach, including short-term clinical and radiographic outcomes and complications. METHODS This was a single-institution, retrospective series of 29 patients between January 2017 and December 2022 for whom a custom glenoid component was created for extensive glenoid bone loss. Patients were evaluated preoperatively and at intervals for up to 5 years. All received preoperative physical examinations, plain radiographs, and computed tomography (CT). Intra- and postoperative complications are reported. RESULTS Of 29 patients, delays resulted in only undergoing surgery, and in three of those, the implant did not match the glenoid. For those three, the time from CT scan to implantation averaged 7.6 months (range, 6.1-10.7 months), compared with 5.5 months (range, 2-8.6 months) for those whose implants fit. In patients with at least 2-year follow-up (n=9), no failures occurred. Significant improvements were observed in all patient-reported outcome measures in those nine patients (American Shoulder and Elbow Score, P<0.01; Simple Shoulder Test, P=0.02; Single Assessment Numeric Evaluation, P<0.01; Western Ontario Osteoarthritis of the Shoulder Index, P<0.01). Range of motion improved for forward flexion and abduction (P=0.03 for both) and internal rotation up the back (P=0.02). Pain and satisfaction also improved (P<0.01 for both). CONCLUSIONS Prolonged time (>6 months) from CT scan to device implantation resulted in bone loss that rendered the implants unusable. Satisfactory short-term radiographic and clinical follow-up can be achieved with a well-fitting device. Level of evidence: III.
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Affiliation(s)
- Punyawat Apiwatanakul
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Prashant Meshram
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Andrew B Harris
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Joel Bervell
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Piotr Łukasiewicz
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Ridge Maxson
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Matthew J Best
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward G McFarland
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Comparison of glenoid bone grafting vs. augmented glenoid baseplates in reverse shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2023; 32:885-891. [PMID: 36581134 DOI: 10.1016/j.jse.2022.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/26/2022] [Accepted: 11/13/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Management of bone loss and glenoid deformity can present a significant challenge to surgeons. The purpose of this review was to compare outcomes of reverse shoulder arthroplasty (RSA) using either bone graft or augmented baseplates for the management of glenoid bone loss and deformity. METHODS A comprehensive search of MEDLINE, Embase, and Cochrane indices was performed for studies reporting clinical outcomes following primary RSA with bone grafting or use of augmented baseplates. Pooled and frequency-weighted means, standard deviations, and ranges were calculated and reported for comparison. RESULTS Overall, 19 studies and 652 patients with bone grafting (n = 401) and augmented baseplates (n = 251) were included in the study. Mean patient age and gender were 70.3 ± 3.1 years and 47% female in the bone grafting group and 72.9 ± 3.7 years and 59.0% female in the augmented baseplate group. Mean follow-up for the augmented baseplate group was 23.1 ± 8.2 months and 29.5 ± 10.1 months for the bone grafting group. Overall complication and revision rates were 11.7% and 4.5% for the bone grafting group and 11.8% and 3.7% for the augmented baseplate group. Range of motion as well as patient-reported and functional outcome scores were similar between both techniques. Infections, component loosening, and notching were 1.9%, 3.6%, and 24.6% in the bone grafting group and 0.7%, 1.6%, and 4.7% in the augmented baseplate group. CONCLUSIONS Glenoid bone grafting and augmented baseplates are effective treatment options for the management of bone loss and glenoid deformity. Both treatments improve overall clinical outcomes with relatively low complication rates and revision rates.
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Ghanta RB, Tsay EL, Feeley B. Augmented baseplates in reverse shoulder arthroplasty: a systematic review of outcomes and complications. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:37-43. [PMID: 37588067 PMCID: PMC10426546 DOI: 10.1016/j.xrrt.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Glenoid wear secondary to primary osteoarthritis or rotator cuff arthropathy is an obstacle commonly encountered by surgeons performing reverse shoulder arthroplasty, with numerous techniques devised to address this finding. The most recent of such techniques is the introduction of augmented glenoid baseplates to fill these glenoid defects. The objectives of this systematic review are to analyze clinical outcomes of augmented baseplates in patients with glenoid wear, including pain, range of motion, patient-reported functional scores, radiographic outcome measures, complication rates, and revision rates. Methods Three online databases (Ovid Medline, EMBASE, Pubmed) were searched for studies publishing clinical and functional outcomes of augmented baseplates in primary reverse shoulder arthroplasty. Findings were aggregated and frequency-weighted means of these variables were calculated when applicable. Results Seven studies comprising 810 patients were included in this review. The mean patient age was 72.1 ± 8.1 years with an average follow-up time of 41.4 months. Frequency-weighted means of improvement in forward elevation, abduction, and active external rotation were 53°, 47°, and 19°, respectively. Patients experienced American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant score improvements of 45.9, 5.9, and 33.7, respectively. Pooled complicated rate was 6.4%, with 10 cases of baseplate loosening and 3 cases of instability. Five (0.6%) patients required reoperation. Subdividing among augment type (posterior, superior, posterosuperior), there were no apparent differences in outcomes or complication rates between directional augments. Conclusion This systematic review demonstrates that augmented baseplates for reverse shoulder arthroplasty provide positive outcomes both clinically and functionally at early follow-up. Complications are within an acceptable range for primary reverse shoulder arthroplasty, with a low rate of revision. Augmented baseplates should serve as a viable option for surgeons seeking to address glenoid wear during reverse shoulder arthroplasty.
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Affiliation(s)
- Ramesh B. Ghanta
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ellen L. Tsay
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
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10
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Karpyshyn JN, Bois AJ, Logan H, Harding GT, Bouliane MJ. 3D Printed Patient-Specific Cutting Guides for Bone Grafting in Reverse Shoulder Arthroplasty: A Novel Technique. J Shoulder Elb Arthroplast 2023; 7:24715492231162285. [PMID: 36937107 PMCID: PMC10017943 DOI: 10.1177/24715492231162285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/01/2023] [Accepted: 02/19/2023] [Indexed: 03/15/2023] Open
Abstract
Glenoid bone loss remains a challenge in shoulder arthroplasty. Addressing substantial bone loss is essential to ensure proper function and stability of the shoulder prosthesis and to prevent baseplate loosening and subsequent revision surgery. Current options for creating and shaping glenoid bone grafts include free-hand techniques and simple reusable cutting guides that cut the graft at a standard angle. There is currently no patient-specific device available that enables surgeons to accurately prepare the bone graft and correct glenoid deformity. We present a novel surgical technique using three-dimensional (3D)-printed cutting guides to create a patient-specific bone graft to address glenoid deformity in the setting of reverse shoulder arthroplasty.
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Affiliation(s)
- Jillian N Karpyshyn
- Department of Orthopaedic Surgery, University of Alberta, Canada
- Jillian Karpyshyn, Department of Orthopaedic Surgery, University of Alberta, 10620 21 Ave NW, Edmonton, Canada, T6J-5G9.
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Heather Logan
- Institute for Reconstructive Sciences in Medicine, University of Alberta, Canada
| | - Graeme T Harding
- Department of Orthopaedic Surgery, University of Alberta, Canada
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11
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Viswanath A, Newell AK, Cunningham LJ, Walton M, Monga P, Bale S, Trail IA. Survivorship of Allologous Structural Bone Graft at a Minimum of 2 Years When Used to Address Significant Glenoid Bone Loss in Revision Shoulder Arthroplasty: A Computed Tomographic and Clinical Review. J Shoulder Elb Arthroplast 2023; 7:24715492231172371. [PMID: 37197294 PMCID: PMC10184218 DOI: 10.1177/24715492231172371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
Background This study assesses outcomes in revision shoulder replacements where the glenoid bone loss was managed using a structural allograft (donated femoral head) in combination with a trabecular titanium (TT) implant. Methods We contacted patients who had undergone revision shoulder arthroplasty using the Lima Axioma TT metal-backed glenoid with an allologous bone graft as a composite who were over 2 years since surgery. Patients underwent computerd tomography evaluation, clinical review, and scoring preoperatively, at 6 months and the latest follow-up. Results Fifteen patients were included with a mean age of 59 (33-76). The average follow-up period was 40.5 months (24-51). 80% showed satisfactory bone graft incorporation and peg integration at the latest follow-up. Three had signs of significant bone graft resorption, although in 2 patients the pegs were still soundly fixed in the host bone. Clinically all patients showed a statistically significant improvement in pain relief, movement, and function. No unusual complications were reported. Conclusion Results show femoral head structural allograft in combination with TT metal-backed glenoid baseplate is a viable option for revision total shoulder replacement in the context of massive glenoid bone loss. We do, however, acknowledge that this resorption rate is higher than in other reported series where autograft is used.
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Affiliation(s)
- Aparna Viswanath
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Amy K Newell
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | | | - Mike Walton
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Puneet Monga
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Steve Bale
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
| | - Ian A Trail
- Upper Limb Research Department, Wrightington Hospital, Lancashire, UK
- Ian A. Trail, Upper Limb Research Department, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, Lancs WN6 9EP, UK.
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12
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Wilcox B, Campbell RJ, Low A, Yeoh T. Management of glenoid bone loss in primary reverse shoulder arthroplasty. Bone Joint J 2022; 104-B:1334-1342. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0819.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims Rates of reverse total shoulder arthroplasty (rTSA) continue to grow. Glenoid bone loss and deformity remains a technical challenge to the surgeon and may reduce improvements in patients’ outcomes. However, there is no consensus as to the optimal surgical technique to best reconstruct these patients’ anatomy. This review aims to compare the outcomes of glenoid bone grafting versus augmented glenoid prostheses in the management of glenoid bone loss in primary reverse total shoulder arthroplasty. Methods This systematic review and meta-analysis evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We performed searches of Medline (Ovid), Embase (Ovid), and PubMed from their dates of inception to January 2022. From included studies, we analyzed data for preoperative and postoperative range of motion (ROM), patient-reported functional outcomes, and complication rates. Results A total of 13 studies (919 shoulders) were included in the analysis. The mean age of patients at initial evaluation was 72.2 years (42 to 87), with a mean follow-up time of 40.7 months (24 to 120). Nine studies with 292 rTSAs evaluated the use of bone graft and five studies with 627 rTSAs evaluated the use of augmented glenoid baseplates. One study was analyzed in both groups. Both techniques demonstrated improvement in patient-reported outcome measures and ROM assessment, with augmented prostheses outperforming bone grafting on improvements in the American Shoulder and Elbow Surgeons Score. There was a higher complication rate (8.9% vs 3.5%; p < 0.001) and revision rate among the bone grafting group compared with the patients who were treated with augmented prostheses (2.4% vs 0.6%; p = 0.022). Conclusion This review provides strong evidence that both bone graft and augmented glenoid baseplate techniques to address glenoid bone loss give excellent ROM and functional outcomes in primary rTSA. The use of augmented base plates may confer fewer complications and revisions. Cite this article: Bone Joint J 2022;104-B(12):1334–1342.
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Affiliation(s)
- Ben Wilcox
- Department of Orthopaedics, John Hunter Hospital, Newcastle, Australia
| | - Ryan J. Campbell
- Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Adrian Low
- University of Sydney, Sydney, Australia
- Department of Orthopaedic Surgery, Sydney Adventist Hospital, Sydney, Australia
| | - Timothy Yeoh
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Sydney, Australia
- Norwest Private Hospital, Sydney, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
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13
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Fraser AN, Bøe B, Fjalestad T, Madsen JE, Röhrl SM. Stable glenoid component of reverse total shoulder arthroplasty at 2 years as measured with model-based radiostereometric analysis (RSA). Acta Orthop 2021; 92:644-650. [PMID: 34196600 PMCID: PMC8635662 DOI: 10.1080/17453674.2021.1943932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Reverse total shoulder arthroplasty (TSA) is used for treating cuff arthropathy, displaced proximal humeral fractures (PHF), and in revision shoulder surgery, despite sparse evidence on long-term results. We assessed stability of the glenoid component in reverse TSA, using model-based RSA.Patients and methods - 20 patients (mean age 76 years, 17 female), operated on with reverse TSA at Oslo University Hospital, in 2015-2017 were included. Indications for surgeries were PHFs, malunion, cuff arthropathy, and chronic shoulder dislocation. RSA markers were placed in the scapular neck, the coracoid, and the acromion. RSA radiographs were conducted postoperatively, at 3 months, 1 year, and 2 years. RSA analysis was performed using RSAcore with Reversed Engineering (RE) modality, with clinical precision < 0.25 mm for all translations (x, y, z) and < 0.7° for rotations (x, z). Scapular "notching" was assessed in conventional radiographs.Results - 1 patient was excluded due to revision surgery. More than half of the patients displayed measurable migration at 2 years: 6 patients with linear translations below 1 mm and 8 patients who showed rotational migration. Except for one outlier, the measured rotations were below 2°. The migration pattern suggested implant stability at 2 years. 10 patients showed radiolographic signs of "notching", and the mean Oxford Shoulder Score (OSS) at 2 years was 29 points (15-36 points).Interpretation - Stability analysis of the glenoid component of reversed total shoulder arthroplasty using reversed engineering (RE) model-based RSA indicated component stability at 2 years.
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Affiliation(s)
- Alexander Nilsskog Fraser
- Institute of Clinical Medicine; University of Oslo,Diakonhjemmet Hospital,Norway,Correspondence: Alexander Nilsskog FRASER,
| | - Berte Bøe
- Division of Orthopaedic Surgery, Oslo University Hospital
| | - Tore Fjalestad
- Division of Orthopaedic Surgery, Oslo University Hospital
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital,Institute of Clinical Medicine; University of Oslo
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14
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Nabergoj M, Neyton L, Bothorel H, Ho SWL, Wang S, Chong XL, Lädermann A. Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study. J Clin Med 2021; 10:jcm10225274. [PMID: 34830556 PMCID: PMC8622484 DOI: 10.3390/jcm10225274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
There are different techniques to address severe glenoid erosion during reverse shoulder arthroplasty (RSA). This study assessed the clinical and radiological outcomes of RSA with combined bony and metallic augment (BMA) glenoid reconstruction compared to bony augmentation (BA) alone. A review of patients who underwent RSA with severe glenoid bone loss requiring reconstruction from January 2017 to January 2019 was performed. Patients were divided into two groups: BMA versus BA alone. Clinical outcome measurements included two years postoperative ROM, Constant score, subjective shoulder value (SSV), and the American Shoulder and Elbow Surgeons Shoulder (ASES) score. Radiological outcomes included radiographic evidence of scapular complications and graft incorporation. The BMA group had significantly different glenoid morphology (p < 0.001) and greater bone loss thickness than the BA group (16.3 ± 3.8 mm vs. 12.0 ± 0.0 mm, p = 0.020). Both groups had significantly improved ROM (anterior forward flexion and external rotation) and clinical scores (Constant, SSV and ASES scores) at 2 years. Greater improvement was observed in the BMA group in terms of anterior forward flexion (86.3° ± 27.9° vs. 43.8° ± 25.6°, p = 0.013) and Constant score (56.6 ± 10.1 vs. 38.3 ± 16.7, p = 0.021). The BA group demonstrated greater functional and clinical improvements with higher postoperative active external rotation and ASES results (active external rotation, 49.4° ± 17.0° vs. 29.4° ± 14.7°, p = 0.017; ASES, 89.1 ± 11.3 vs. 76.8 ± 11.0, p = 0.045). The combination use of bone graft and metallic augments in severe glenoid bone loss during RSA is safe and effective and can be considered in cases of severe glenoid bone loss where bone graft alone may be insufficient.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, 6280 Ankaran, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Lionel Neyton
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 69008 Lyon, France;
| | - Hugo Bothorel
- Research Department, La Tour Hospital, 1217 Meyrin, Switzerland;
| | - Sean W. L. Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Sidi Wang
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland; (S.W.); (X.L.C.)
| | - Xue Ling Chong
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland; (S.W.); (X.L.C.)
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, 1217 Meyrin, Switzerland; (S.W.); (X.L.C.)
- Faculty of Medicine, University of Geneva, 1211 Geneva 4, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-22-719-75-55; Fax: +41-22-719-60-77
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15
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Verstuyft L, Vergison L, Van Tongel A, De Wilde L. Is bone grafting always necessary in revision reverse total shoulder arthroplasty with uncontained glenoid bone defects? J Shoulder Elbow Surg 2021; 30:1891-1898. [PMID: 33276161 DOI: 10.1016/j.jse.2020.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/21/2020] [Accepted: 10/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with an uncontained glenoid bone defect can still successfully undergo a reverse total shoulder arthroplasty (RTSA). Currently, there is a tendency toward reconstruction of the premorbid glenoid plane with bone grafts, which is technically demanding. We investigated whether central peg positioning in the spine pillar (CPPSP) is a more feasible alternative to the use of bone grafts. METHODS This study included 60 revisions to an RTSA with uncontained glenoid bone defects. Patients were treated with bone grafts in 29 cases and with the CPPSP technique in 31 cases. We assessed clinical results using the Constant score and assessed the complication rate. RESULTS The Constant score changed from 42 to 69 points in the CPPSP group and from 47 to 60 points in the bone graft group. This difference in the increase in the Constant score was significant (P = .031) owing to a significant difference in strength in favor of the CPPSP group. The overall complication rate was 37.7% (20 of 53 patients), with a reoperation rate of 18.9% (10 of 53). Dislocations occurred only in the CPPSP group (n = 3), and loosening of the glenoid occurred only in the bone graft group (n = 3). CONCLUSION Patients with uncontained glenoid bone defects undergoing revision to an RTSA obtain similar clinical results with the CPPSP technique compared with the use of bone grafts. The CPPSP technique is a valid alternative but results in different complications.
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Affiliation(s)
- Lotte Verstuyft
- Department of Orthopaedic Surgery and Traumatology, UZ Gent, Gent, Belgium.
| | - Laurence Vergison
- Department of Orthopaedic Surgery and Traumatology, UZ Gent, Gent, Belgium
| | | | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, UZ Gent, Gent, Belgium
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Baseplate Options for Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2020; 13:769-775. [PMID: 33034820 DOI: 10.1007/s12178-020-09677-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Baseplate fixation has been known to be the weak link in reverse total shoulder arthroplasty (RTSA). A wide variety of different baseplates options are currently available. This review investigates the recent literature to present the reader with an overview of the currently available baseplate options and modes of fixation. RECENT FINDINGS The main elements that differentiate baseplates are the central fixation element, the size of the baseplate, the shape, the backside geometry, whether or not an offset central fixation exists, the number of peripheral screws, and the availability of peripheral augmentation. The wide array of baseplate options indicates that no particular design has proven superiority. As such, surgeons should be aware of their options and choose an implant that the surgeon is comfortable with and one that best suits the individual patient anatomy. With the growing number of RTSA procedures and registries with long-term follow-up, future investigations will hopefully delineate the ideal baseplate design to optimize survivorship.
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