Angled BIO-RSA (bony-increased offset-reverse shoulder arthroplasty): a solution for the management of glenoid bone loss and erosion

Autor: Nicolas Holzer, Gilles Walch, Brian L. Seeto, Pascal Boileau, Nicolas Morin-Salvo, Peter N. Chalmers, Marc-Olivier Gauci
Rok vydání: 2016
Předmět:
Male
Glenoid Cavity
medicine.medical_treatment
Bone Screws
Glenoid cavity
0302 clinical medicine
Scapula
Glenoid erosion
Orthopedics and Sports Medicine
Range of Motion
Articular
Orthodontics
Aged
80 and over
030222 orthopedics
Bone Transplantation
ddc:617
Shoulder Joint
General Medicine
Bony lateralization
Glenoid inclination
Middle Aged
musculoskeletal system
medicine.anatomical_structure
Surgery
Computer-Assisted
Arthroplasty
Replacement
Shoulder
Female
Bony-increased offset reverse shoulder arthroplasty (BIO-RSA)
Range of motion
Bone Plates
musculoskeletal diseases
medicine.medical_specialty
03 medical and health sciences
Notching
Bone plate
medicine
Humans
Humerus
Glenoid retroversion
Aged
business.industry
Glenoid bone loss
030229 sport sciences
Arthroplasty
Surgery
Humeral Head
Shoulder joint
business
Tomography
X-Ray Computed
Reverse total shoulder arthroplasty
Follow-Up Studies
Zdroj: Journal of Shoulder and Elbow Surgery, Vol. 26, No 12 (2017) pp. 2133-2142
ISSN: 1532-6500
1058-2746
Popis: Glenoid deficiency and erosion (excessive retroversion/inclination) must be corrected in reverse shoulder arthroplasty (RSA) to avoid prosthetic notching or instability and to maximize function, range of motion, and prosthesis longevity. This study reports the results of RSA with an angled, autologous glenoid graft harvested from the humerus (angled BIO-RSA).A trapezoidal bone graft, harvested from the humeral head and fixed with a long-post baseplate and screws, was used to compensate for residual glenoid bone loss/erosion. For simple to moderate (25°) glenoid defects, standardized instrumentation combined with some eccentric reaming (15°) was used to reconstruct the glenoid and obtain neutral implant alignment. For severe (25°) and complex (multiplanar) glenoid bone defects, patient-specific grafts and guides were used after 3-dimensional planning. Patients were reviewed with minimum 2 years of follow-up. Mean follow-up was 36 months (range, 24-81 months). Preoperative and postoperative measurements of inclination and version were performed in the plane of the scapula on computed tomography images.The study included 54 patients (41 women, 13 men; mean 73 years old). Fifteen patients had combined vertical and horizontal glenoid bone deficiency. Among E2/E3 glenoids, inclination improved from 37° (range, 14° to 84°) to 10.2° (range -28° to 36°, P .001). Among B2/C glenoids, retroversion improved from -21° (range, -49° to 0°) to -10.6° (-32° to 4°, P = .06). Complete radiographic incorporation of the graft occurred in 94% (51 of 54). Complications included infection in 1 and clinical aseptic baseplate loosening in 2. Mild notching occurred in 25% (13 of 51) of patients. Constant-Murley and Subjective Shoulder Value assessments increased from 31 to 68 and from 30% to 83%, respectively (P .001).Angled BIO-RSA predictably corrects glenoid deficiency, including severe (25°) multiplanar deformity. Graft incorporation is predictable. Advantages of using an autograftharvested in situ include bone stock augmentation, lateralization, low donor-site morbidity, low relative cost, and flexibility needed to simultaneously correct posterior and superior glenoid defects.
Databáze: OpenAIRE
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