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Ingoe H, Italia K, Gilliland L, Kang HW, Karel M, Maharaj J, Cutbush K, Gupta A. The Use of Glenoid Structural Allografts for Glenoid Bone Defects in Reverse Shoulder Arthroplasty. J Clin Med 2024; 13:2008. [PMID: 38610773 PMCID: PMC11012575 DOI: 10.3390/jcm13072008] [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: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The use of reverse shoulder arthroplasty as a primary and revision implant is increasing. Advances in implant design and preoperative surgical planning allow the management of complex glenoid defects. As the demand for treating severe bone loss increases, custom allograft composites are needed to match the premorbid anatomy. Baseplate composite structural allografts are used in patients with eccentric and centric defects to restore the glenoid joint line. Preserving bone stock is important in younger patients where a revision surgery is expected. The aim of this article is to present the assessment, planning, and indications of femoral head allografting for bony defects of the glenoid. Methods: The preoperative surgical planning and the surgical technique to execute the plan with a baseplate composite graft are detailed. The preliminary clinical and radiological results of 29 shoulders which have undergone this graft planning and surgical technique are discussed. Clinical outcomes included visual analogue score of pain (VAS), American Shoulder and Elbow Surgeons score (ASES), Constant-Murley score (CS), satisfaction before and after operation, and active range of motion. Radiological outcomes included graft healing and presence of osteolysis or loosening. Results: The use of composite grafts in this series has shown excellent clinical outcomes, with an overall graft complication rate in complex bone loss cases of 8%. Conclusion: Femoral head structural allografting is a valid and viable surgical option for glenoid bone defects in reverse shoulder arthroplasty.
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Affiliation(s)
- Helen Ingoe
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
| | - Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
- Akunah, Brisbane, QLD 4120, Australia
| | - Luke Gilliland
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
- Akunah, Brisbane, QLD 4120, Australia
| | - Hean Wu Kang
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
| | - Mirek Karel
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
| | - Jashint Maharaj
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia; (H.I.); (K.I.); (L.G.); (H.W.K.); (M.K.); (J.M.); (K.C.)
- Akunah, Brisbane, QLD 4120, Australia
- Queensland Orthopaedic Clinic, Greenslopes Private Hospital, Brisbane, QLD 4000, Australia
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Italia K, Launay M, Gilliland L, Nielsen J, Pareyon R, Hollman F, Salhi A, Maharaj J, Jomaa M, Cutbush K, Gupta A. Single-Stage Revision Reverse Shoulder Arthroplasty: Preoperative Planning, Surgical Technique, and Mixed Reality Execution. J Clin Med 2022; 11:jcm11247422. [PMID: 36556038 PMCID: PMC9788296 DOI: 10.3390/jcm11247422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/07/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Revision shoulder arthroplasty is increasing with the number of primary shoulder replacements rising globally. Complex primary and revisions of shoulder arthroplasties pose specific challenges for the surgeon, which must be addressed preoperatively and intraoperatively. This article aimed to present strategies for the management of revision of shoulder arthroplasties through a single-stage approach. Preoperatively, patient factors, such as age, comorbidities, and bone quality, should be considered. The use of planning software can aid in accurately evaluating implants in situ and predict bony anatomy that will remain after explantation during the revision surgery. The planning from such software can then be executed with the help of mixed reality technology to allow accurate implant placement. Single-stage revision is performed in two steps (debridement as first step, implantation and reconstruction as the second step), guided by the following principles: adequate debridement while preserving key soft tissue attachments (i.e., rotator cuff, pectoralis major, latissimus dorsi, deltoid), restoration of glenoid joint line using bone grafting, restoration of humeral length, reconstruction and/or reattachment of soft tissues, and strict compliance with the postoperative antibiotic regimen. Preliminary results of single-stage revision shoulder arthroplasty show improvement in patient outcomes (mean 1 year), successful treatment of infection for those diagnosed with periprosthetic joint infection, and improved cost-benefit parameters for the healthcare system.
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Affiliation(s)
- Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Correspondence: (K.I.); or (A.G.); Tel.: +61-7-3208-5552 (A.G.)
| | - Marine Launay
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - Luke Gilliland
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - James Nielsen
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - Roberto Pareyon
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Freek Hollman
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Asma Salhi
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
| | - Jashint Maharaj
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Mohammad Jomaa
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Brisbane Private Hospital, Brisbane, QLD 4000, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD 4000, Australia
- Akunah, Brisbane, QLD 4120, Australia
- Greenslopes Private Hospital, Brisbane, QLD 4120, Australia
- Correspondence: (K.I.); or (A.G.); Tel.: +61-7-3208-5552 (A.G.)
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