Glenoid reconstruction with autologous humeral head for glenoid dysplasia in reverse shoulder arthroplasty.
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ABSTRACT:
SUBMITTER: Mc Millan S
PROVIDER: S-EPMC10426553 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
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Glenoid reconstruction with autologous humeral head for glenoid dysplasia in reverse shoulder arthroplasty.
Mc Millan Sean S Ford Elizabeth E Favorito Paul P
JSES reviews, reports, and techniques 20210128 2
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Project description:Advanced glenohumeral osteoarthritis can transform glenoid morphology and, in some cases, is found in association with severe glenoid retroversion. The associated glenoid retroversion leads to difficulty in fixation of the glenoid component in reverse total shoulder arthroplasty. In the context of extreme glenoid wear, structural grafts can be used to restore glenoid volume and version in order for the glenoid component of the reverse total shoulder arthroplasty to be more easily implanted. Nevertheless, literature regarding structural grafts remains limited, with optimal graft choice and technique still controversial at best. This article details our technique for humeral head autograft transplantation before reverse total shoulder arthroplasty in the context of extreme glenoid retroversion with advanced osteoarthritis.
| S-EPMC5794907 | biostudies-literature
Project description:Failed shoulder arthroplasty associated with glenoid bony deficiency is a difficult problem. Revision surgery is complex with unpredictable outcome. We asked whether revision shoulder arthroplasty with glenoid bone grafting could lead to good outcome. We retrospectively reviewed 21 patients who underwent glenoid bone grafting using corticocancellous bone grafting or impaction grafting using cancellous bone graft. Three patients underwent revision TSA, five patients hemiarthroplasty, 10 patients hemiarthroplasty with biologic resurfacing of the glenoid, and three patients revision to reverse TSA. The patients had minimum 25 months followup (average, 45 months; range, 25-92 months). All patients had improvement in their range of motion and the Constant-Murley score. Most improvement occurred in patients with glenoid reimplantation. Patients who underwent revision reverse TSA had improvement in shoulder flexion but decrease in external rotation motion. We conclude revision shoulder arthroplasty with glenoid bone grafting can produce good short-term outcome and glenoid component reinsertion should be attempted whenever possible.
| S-EPMC2505201 | biostudies-other
Project description:BackgroundMetallic humeral and glenoid lateralized implants have been developed to prevent common problems that can emerge using Grammont's concept (ie, medialization of center of rotation, decreased humeral offset, scapular notching) in reverse shoulder arthroplasty. The purpose of this study was to evaluate the clinical and radiological results of metallic humeral and glenoid lateralized implants for cuff tear arthropathy (CTA) and primary osteoarthritis (OA).MethodsIn this prospective study, patients with CTA or OA who underwent reverse shoulder arthroplasty using augmented base plates for glenoid lateralization and a "curved stem" design for the humeral side were included. The Constant-Murley score and Subjective Shoulder Value were documented at 1- and 2-year follow-ups. Radiographs were reviewed for scapular notching, instability, loosening, osteolysis, ossification, bone resorption, or fractures. Lateralization and distalization shoulder angles were evaluated at the final follow-up.ResultsThere were 23 patients with CTA and 19 patients with OA (27 women; mean age, 76 years; range, 59-85) available for examination at 2 years. Both groups increased significantly in all outcome measures compared with baseline (P < .01). Although patients with OA generally had lower baseline scores, the outcome scores were similar and did not show any statistically significant differences. The mean Constant-Murley score and Subjective Shoulder Value at the final follow-up were 78 points (standard deviation [SD] 10) and 84% (SD 11) for patients with CTA, respectively, and corresponding values were 80 points (SD 16) and 92% (SD 12) for the OA group. No scapular notching was observed. The mean value of the lateralization shoulder angle was 81.5° (SD 9.7) and for the distalization shoulder angle was 54.8° (SD 9.4). Neither scapular spine fractures nor instability was observed in this patient cohort.ConclusionMetallic humeral and glenoid lateralization achieves excellent clinical results in terms of shoulder function, pain relief, muscle strength, and patient-reported subjective assessment without instability or radiographic signs of scapular notching. Patients with primary OA showed an overall trend toward better clinical improvement than patients with CTA.
| S-EPMC8888182 | biostudies-literature
Project description:Revision surgery for a failed Latarjet procedure is rare and technically demanding with few viable options. Similarly, massive defects to the articular humeral head require thoughtful techniques to recreate a congruent joint. Revision options for failed Latarjet have been studied, but there is yet to be a consensus on graft options. Distal tibial allograft has shown favorable outcomes in midterm data. Humeral head osteochondral allograft has also shown favorable outcomes for very large humeral head defects. However, there is a paucity of literature to demonstrate efficacy of combining the 2 aforementioned techniques. Revision shoulder instability surgery with glenoid reconstruction using distal tibial allograft and humeral head reconstruction using osteochondral allograft restores the glenohumeral articulation while preserving the remaining native bone stock.
| S-EPMC9051981 | biostudies-literature
Project description:BackgroundPosterior humeral head (HH) subluxation after anatomic total shoulder arthroplasty (aTSA) is associated with worse outcomes, but it is unclear how corrective glenoid reaming correlates with HH alignment and whether HH alignment changes over time. Therefore, it was aimed to analyze the relationship between HH alignment and the scapula following aTSA to identify anatomic and surgical factors that contribute to realignment of the HH, glenoid loosening, and clinical outcomes.MethodsThree-dimensional scapulohumeral alignment was assessed on three-dimensionally reconstructed computed tomography scans of 23 patients: preoperative (T0), 2 years post-aTSA (T1), and ≥5 years post-aTSA (T2). Anterior-posterior (AP), superior-inferior (SI), and medial-lateral offset measures of the HH center to the scapula were referenced to the HH diameter (scapulohumeral subluxation index). Glenoid version and inclination were measured at T0 and T1. Central peg osteolysis, rotator cuff fatty infiltration, and vault perforation were assessed on two-dimensional computed tomography. Relative Constant Score at T2 measured clinical outcome.ResultsGlenoid correction correlated strongly with AP and SI position of the HH (r = 0.733 and r = 0.797, respectively). Each degree of retroversion correction resulted in 0.9% AP scapulohumeral subluxation index offset change toward anterior. Each degree of inclination correction to superior resulted in a 1.0% offset change toward superior. A gradual postoperative proximal (mean difference [MD], -3%; P = .019), anterior (MD, 2%; P = .025), and medial (MD, 3 mm; P < .001) HH migration was observed. Asymmetric progressive rotator cuff fatty infiltration was associated with the direction of change in AP alignment over time (odds ratio, 2.04; P = .046), with progressive subscapularis fatty infiltration as the primary factor associated with gradual anterior HH translation (odds ratio, 15.61; P = .028). Gradual HH medialization was an indicator of glenoid components at risk for loosening (difference between medians, 4 mm; P = .003). Osteolysis around the central glenoid peg was influenced by overcorrection of glenoid version (MD, 7°; P = .038). Preoperative glenoid inclination was the sole anatomical or surgical factor predicting clinical outcome, as larger inferior inclination at T0 was associated with worse relative Constant Score at T2 (P = .016).ConclusionCorrective glenoid reaming was an effective surgical technique to correct HH alignment in the AP and SI direction. Gradual anterior HH translation after aTSA was associated with progressive subscapularis fatty infiltration, and substantial HH medialization was an important indicator for potential glenoid loosening. While postoperative glenoid version and AP HH alignment were important for radiographic outcome, preoperative glenoid inclination predicted clinical outcome, as larger preoperative inferior inclination resulted in worse clinical scores.
| S-EPMC10229416 | biostudies-literature
Project description:Component positioning is a key factor for avoiding complications and improving functional outcomes in reverse shoulder arthroplasty. Preoperative planning can improve component positioning. However, translating the preoperative plan into the surgical procedure can be challenging. This is particularly the case for the glenoid component positioning in severe deformity or limited visualization of the scapula. Different computational-assisted techniques have been developed to aid implementation of the preoperative plan into the surgical procedure. Navigated augmented reality (AR) refers to the real world augmented with virtual real-time information about the position and orientation of instruments and components. This information can be presented through a head-mounted display (HMD), which enables the user to visualize the virtual information directly overlaid onto the real world. Navigated AR systems through HMD have been validated for shoulder arthroplasty using phantoms and cadavers. This article details a step-by-step guide use of a navigated AR system through HMD, in the placement of the glenoid bony-augmented component.
| S-EPMC9134485 | biostudies-literature
Project description:BackgroundReverse total shoulder arthroplasty (RTSA) provides reconstructive options in patients previously not candidates for total shoulder arthroplasty (TSA) or who have failed previous anatomic TSA. Revision from anatomic TSA to RTSA previously required removal of all components, a difficult and extensive procedure. Modular humeral components permit conversion from anatomic TSA to RTSA without removal of well-fixed humeral components.Questions/purposesOur purpose is to present a case series of patients treated for the unique and not previously reported complication of humeral tray-taper failure following modular RTSA. Challenges in diagnosis and treatment are described, including the use of dynamic fluoroscopy and manufacturer-specific instruments for component revision.MethodsFive patients with a total of six humeral tray-taper failures were identified from 300 patients with first-generation (titanium) humeral trays over a 7-year period. Dynamic fluoroscopic evaluation aided in diagnosis in a majority of the cases. All cases have been revised to second-generation (cobalt chrome) humeral trays.ResultsAverage follow-up was 22 ± 23 months (range 3-60 months). One individual required a second revision for the same complication, but otherwise, no additional procedures were required. Symptom relief was obtained in all patients.ConclusionsThis case series illustrates a previously unpublished complication of humeral tray-taper junction failure following modular RTSA. Clinical and radiographic diagnosis is challenging; however, dynamic fluoroscopic evaluation permits identification of the component failure, and revision surgery results in good outcomes. We must, however, continue to evaluate what activities are recommend for patients following shoulder arthroplasty, specifically reverse total shoulder arthroplasty.
| S-EPMC4733694 | biostudies-literature
Project description:Background and objectivesIsolated bone tumors of the glenoid are exceedingly rare occurrence and pose a substantial surgical challenge. 3D printing technology has been proved to be a reliable tool to reconstruct complex anatomical part of the skeleton. We initially used this technology to reconstruct the glenoid component of the shoulder in a hemiarthroplasty configuration. We subsequently changed to a reverse shoulder arthroplasty.MethodsTwo patients were reconstructed with a hemiarthroplasty and 2 with a reverse configuration. Patients files were reviewed for radiographic analysis, pain and function scores.ResultsMean follow-up was 36.44 ± 16.27 months. All patients are alive and disease free. The two patients who benefitted from a hemiarthroplasty demonstrated a rapid deterioration of the proximal humeral articular surface. Given their pain and function scores, they subsequently required revision towards a total shoulder arthroplasty. Following this conversion, one patient presented a shoulder dislocation requiring surgical reintervention. We did not observe any loosening or infection in this short series.ConclusionsCustom made glenoid reconstruction should be designed as a reverse shoulder arthroplasty given the mechanical constrains on the proximal humerus and the extent of the surgery invariably damaging the suprascapular neurovascular bundle.
| S-EPMC11521977 | biostudies-literature
Project description:BackgroundDegenerative arthritis of the shoulder is a common condition that is successfully treated with anatomic total shoulder arthroplasty (TSA). Rotator cuff disease has evolved as a leading cause of failure of anatomic TSA, requiring revision to reverse shoulder arthroplasty (RSA). This revision procedure can be extremely complex, particularly if removal of a well-fixed glenoid component is necessary. This case series outlines the technique and preliminary clinical results of conversion of anatomic TSA to RSA utilizing both modular humeral and hybrid glenoid components.MethodsFrom July 2017 to December 2019, the senior author (PMC) performed 84 consecutive anatomic TSA procedures utilizing a modular humeral arthroplasty system and a unique hybrid glenoid component. Three cases (3/84, or 3.6%) required conversion from anatomic TSA to RSA because of postoperative traumatic rotator cuff failure. All modular revision cases were performed without humeral stem removal and with utilization of the existing, well-fixed hybrid glenoid central titanium peg as the foundation for glenoid component revision. Preoperative and postoperative American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, forward flexion, and patient satisfaction were analyzed in this modular revision group. In addition, several perioperative variables including operative time, blood loss, and length of stay were compared between this modular revision group and a nonmodular anatomic TSA to RSA revision comparative cohort.ResultsAt an average follow-up of 24 months, average active forward flexion, postoperative American Shoulder and Elbow Surgeons scores, and visual analog scale pain scores improved significantly compared with preoperative scores in the modular revision group. All three patients were satisfied with their outcome. The average total operative time (109 minutes vs. 154 minutes, P = .02), blood loss (183 cc vs. 500 cc, P = .08), and length of hospital stay (26.3 hours vs. 36.6 hours P < .05) were lower in the modular revision group than those in a nonmodular revision cohort.ConclusionRevision of anatomic TSA to RSA utilizing a modular humeral system and a convertible hybrid glenoid component that does not require removal of a well-fixed central titanium peg which serves as the foundation for glenoid component revision was performed efficiently, safely, and successfully in three cases. This technique results in significantly improved clinical outcomes when revision to RSA is needed while potentially decreasing perioperative complications in the revision setting.
| S-EPMC10426665 | biostudies-literature
Project description:Background:Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA). Questions/Purposes:The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN. Methods:Patients who underwent TSA were identified in the PearlDiver database using ICD-9 codes. Patients who underwent shoulder arthroplasty for humeral head AVN were identified using ICD-9 codes and were subclassified according to AVN etiology (posttraumatic, alcohol use, chronic steroid use, and idiopathic). Complications evaluated included postoperative infection within 6 months, dislocation within 1 year, revision shoulder arthroplasty up to 8 years postoperatively, shoulder stiffness within 1 year, and periprosthetic fracture within 1 year and systemic complications within 3 months. Postoperative complication rates were compared to controls. Results:The study cohorts included 4129 TSA patients with AVN with 141,778 control TSA patients. Patients with posttraumatic AVN were significantly more likely to have a postoperative infection (OR 2.47, P < 0.001), dislocation (OR 1.45, P = 0.029), revision surgery (OR 1.53, P = 0.001), stiffness (OR 1.24, P = 0.042), and systemic complication (OR 1.49, P < 0.001). Steroid-associated AVN was associated with a significantly increased risk for a postoperative infection (OR 1.72, P = 0.004), revision surgery (OR 1.33, P = 0.040), fracture (OR 2.76, P = 0.002), and systemic complication (OR 1.59, P < 0.001). Idiopathic and alcohol-associated AVN were not significantly associated with any of the postoperative evaluated complications. Conclusions:TSA in patients with humeral head AVN is associated with significantly increased rates of numerous postoperative complications compared to patients without a diagnosis of AVN, including infection, dislocation, revision arthroplasty, stiffness, periprosthetic fracture, and medical complications. Specifically, AVN due to steroid use or from a posttraumatic cause appears to be associated with the statistically highest rates of postoperative TSA complications. Given these findings, orthopedic surgeons should be increasingly aware of this association, which should influence the shared decision-making process of undergoing TSA in patients with humeral head AVN.
| S-EPMC5786582 | biostudies-literature