Outcomes after shoulder arthroplasty revision with glenoid reconstruction and bone grafting

Abstract

Purpose: Extensive glenoid bone loss after failed shoulder arthroplasty represents a challenge for revision arthroplasty. Treatment options vary widely and have been a source of controversy among experts.

Methods: Between 2004 and 2010, a total of 17 patients underwent glenoid reconstruction surgery using an autologous iliac crest bone graft and secondary revision arthroplasty due to extensive glenoid bone loss after failed previous total shoulder arthroplasty. The outcomes were assessed by means of clinical examination, Constant score, and bi-plane radiography as well as pre-, postoperative and follow-up CT.

Results: Before the revision surgery, the mean Constant score was 24 ± 17 and improved to 40 ± 13 after the glenoid rebuilding and revision arthroplasty. CT imaging revealed adequate glenoid bone stock restoration with no relevant graft resorption or loosening of the glenoid. The average postoperative antero-posterior diameter of the glenoid was 28 ± 3 mm which had decreased to 25 ± 3 mm at follow-up. The average postoperative version of the glenoid was 95.7° ± 6° and had decreased to 98.5° ± 4° at follow-up. Both the glenoid version and diameter had changed significantly (P < 0.001) comparing postoperative and follow-up CT-scans.

Conclusion: Glenoid reconstruction surgery using an iliac crest bone-block autograft prior to revision arthroplasty represents a valuable salvage procedure in cases of extensive glenoid bone loss after primary shoulder arthroplasty. Sufficient glenoid bone stock restoration is indispensable for reliable fixation of glenoid components and in turn a satisfactory clinical outcome.

Fig. 1

Cemented humeral spacer after autologous bone grafting. a Postoperative axillary radiograph. b Postoperative AP radiograph

Fig. 2

a Autologous iliac crest bone graft. b Autologous bone graft fixed with two cannulated 2.7-mm titanium screws on the glenoid

Fig. 3

Chronological sequence of the two-step process in a patient with a structural autologous iliac crest bone graft. a Preoperative AP radiograph eight years after a TSA. b Postoperative radiograph showing an iliac crest bone autograft fixed with two screws. c Three-year follow-up AP radiograph showing good graft incorporation and no radiolucent lines (RLLs) around the glenoid component

Fig. 4

Axial CT showing the measurement technique applied measuring the antero-posterior diameter of the glenoid preoperative, postoperative and at follow-up

Fig. 5

Comparison of postoperative and follow-up averages of the version of the graft-augmented glenoid in relation to the contralateral side

Fig. 6

Comparison of postoperative and follow-up averages of the antero-posterior diameter of the graft-augmented glenoid in relation to the contralateral side

Fig. 7

Axillary CT at a follow-up examination showing a patient with autologous iliac crest autograft incorporation and an implanted polyethylene glenoid. A new glenoid vault and version were created