Functional and Radiological Outcomes after Treatment with Custom-Made Glenoid Components in Revision Reverse Shoulder Arthroplasty

Abstract

Glenoid implant position and fixation are challenging in severe glenoid defects in reverse total shoulder arthroplasty (rTSA). Custom-made glenoid implants are metal augmented implants that are specially produced for a certain defect. They provide the restoration of the joint line and proper fixation. This retrospective data analysis investigated the clinical and radiological outcomes after revision using custom-made glenoid implants. Between 2018 and 2020, nine patients (10 shoulders) with severe glenoid defects underwent revision rTSA using a custom-made glenoid implant (Materialise Glenius or Lima ProMade). The pre- and postoperative Constant Murley Score (CMS), UCLA Score and Subjective Shoulder Value (SSV) were assessed. Postoperative CT scans and X-rays in two planes were available. The minimum follow-up was 12 months, with a mean follow-up of 23.1 months. The mean preoperative CMS, UCLA Score and SSV were 10.9, 4.1 and 11.0, respectively. The mean postoperative CMS, UCLA Score and SSV showed significant increases of 51.7 (<0.001), 22.9 (<0.001) and 52.0 (<0.001), respectively. There were no signs of loosening implants or scapular notching, and no revision was necessary. This trial showed promising clinical and radiological short-term outcomes for custom-made glenoid components in revision rTSA.

Keywords: custom-made prosthesis; glenoid bone loss; reverse total shoulder arthroplasty; revision total shoulder arthroplasty.

Figure 1

One case of revision reverse total shoulder arthroplasty severely damaged glenoid in the setting of implant loosening after anatomical TSA. Preoperative X-rays were performed in the (A) anteroposterior and (B) axial directions. (C) The surgical procedure consisted of two-time revision with explantation of the anatomical prosthesis and exclusion of infection via sonication and tissue samples. (D) Surgery using a custom-made glenoid component was performed after confirmation of aseptic loosening.

Figure 2

Restoration of the original glenoid surface via statistical shape modelling. Source: planning report provided by Materialise NV, Leuven, Belgium. Reprinted with permission from Materialise. ©2021 Materialise NV.

Figure 3

The postoperative report shows little difference between the planned and actual positions. Source: planning report provided by Materialise NV, Leuven, Belgium. Reprinted with permission from Materialise. ©2021 Materialise NV.

Figure 4

Second case of revision rTSA. The preoperative X-ray (A) after removal of the prior implant shows extensive damage of the glenoid and the proximal humerus. Bone fragments (orange) and excess cement (grey) can be seen in the CT-scan (B), while the preoperative model (C) shows the scapula after the removal of these fragments. The final outcome shows the glenoid implant in the correct position (D). Reprinted with permission from Materialise. ©2021 Materialise NV.

Figure 5

Third case of a revision rTSA. The preoperative situation is displayed in the images on the top (A,B). The bottom images show the outcome in AP (C) and lateral direction (D). Reprinted with permission from Materialise. ©2021 Materialise NV.