Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid

Jm. Hill et Tr. Norris, Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid, J BONE-AM V, 83A(6), 2001, pp. 877-883
Citations number
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
Journal title
ISSN journal
0021-9355 → ACNP
Year of publication
877 - 883
SICI code
Background: The marked loss of glenoid bone volume or alteration of glenoid version can affect glenoid component fixation in patients undergoing total shoulder arthroplasty. The purpose of this study was to evaluate the long- term results associated with the use of bone-grafting for restoration of gl enoid volume and version at the time of total shoulder arthroplasty. Methods: Twenty-one shoulders received an internally fixed, corticocancello us bone graft for the restoration of peripheral glenoid bone stock at the t ime of total shoulder arthroplasty between 1980 and 1989. Grafting was indi cated when glenoid bone stock was insufficient to maintain adequate version or fixation of the prosthesis. Seventeen shoulders were available for foll ow-up; the average duration of follow-up for the thirteen shoulders that di d not have prosthetic failure within the first two years was seventy months . Total shoulder arthroplasty was performed because of osteoarthritis in fi ve shoulders, chronic anterior fracture-dislocation in five, capsulorrhaphy arthropathy in three, inflammatory arthritis in two, recurrent dislocation in one, and failure of a previous arthroplasty in one. All patients had so me form of anterior or posterior instability preoperatively. There were fiv e anterior and twelve posterior glenoid defects. Bone from the resected hum eral head was used for grafting in fifteen shoulders, and bicortical iliac- crest bone was used in two. Results: The average glenoid version after grafting was 4 degrees of retrov ersion, with an average correction of 33 degrees. The graft failed to maint ain the original correction in three shoulders due to nonunion, dissolution , or shift. Five total shoulder replacements failed, necessitating glenoid revision at two to ninety-one months postoperatively. The failures were ass ociated with recurrent massive cuff tears tone shoulder), persistent instab ility (two shoulders), improper component placement tone shoulder), and los s of graft fixation tone shoulder). There were no humeral component failure s, According to the criteria of Neer et al., the functional result was rate d as excellent in three shoulders, satisfactory in six, and unsatisfactory in eight. Conclusions: Despite the finding that eight shoulders had an unsatisfactory functional result at the time of longterm follow-up, corticocancellous gra fting of the glenoid successfully restored glenoid version and volume in fo urteen of the seventeen shoulders in the present study. Patients with gleno id deficiency often have associated glenohumeral instability, which may aff ect the results of total shoulder arthroplasty. Bone-grafting of the glenoi d is a technically demanding procedure that can restore bone stock in patie nts with structural defects.