Glenohumeral arthrodesis

Abstract

Glenohumeral arthrodesis is a salvage procedure indicated for brachial plexus palsy, refractory instability, humeral and/or glenoid bone loss, deltoid and rotator cuff insufficiency, and chronic infections. The aim is to provide a painless, stable shoulder that is positioned to maximize function. Scapulothoracic motion as well as motion of the elbow and hand deliver satisfactory function in most patients. Intra-articular, extra-articular, and more commonly, combined techniques involving glenohumeral and humeroacromial fusion, have been described. More recently, authors have reported arthroscopic assisted techniques for shoulder arthrodesis with promising results as well as less complicated conversion from shoulder arthrodesis to reverse total shoulder arthroplasty. Despite advances in materials and techniques, glenohumeral arthrodesis continues to be associated with complication rates as high as 43%. A thorough understanding of the indications, contraindications, outcomes, and complications is paramount to improving patient results. Glenohumeral arthrodesis is a safe and effective procedure for the appropriate indications. The high frequency of complications mandates a frank preoperative discussion to ensure that each patient understands the magnitude of the procedure, its risks, possible complications, and expected outcome.

Keywords: Glenohumeral arthrodesis; Glenohumeral fusion; Glenohumeral salvage; Shoulder arthrodesis; Shoulder fusion; Shoulder salvage.

Figure 1

Intraoperative photos depicting a lateral approach to the glenohumeral joint for shoulder arthrodesis. (A) The deltoid is released off the acromion and rotator cuff tendons released off of the greater and lesser tuberosities of the proximal humerus, giving access to the glenoid and proximal humerus. (B and C) With the humeral head retracted posteriorly, the glenoid is reamed down to subchondral bone in preparation for fusion. The incision is extended along the spine of the scapula and down the axis of the humerus to accommodate plate fixation.

Figure 2

(A) Preoperative and (B) 6-week postoperative radiographs of a 64-year-old female with a history of terrible chronic shoulder pain after an arthroscopic procedure several years prior. The patient was found to have chronic infection and significant bone loss of the glenoid and acromion on CT scan, precluding any viable reconstructive arthroplasty options. Radiograph B shows a combined intra- and extra-articular fusion with contoured plate fixation between the acromion and humerus, supplemented by 6.5-mm cancellous screws across the glenohumeral joint and cables encircling the humeral shaft and spine of the scapula. CT, computed tomography.