Clinical and Radiographic Outcomes of Total Shoulder Arthroplasty with Bone Graft for Osteoarthritis with Severe Glenoid Bone Loss

Abstract

Glenohumeral osteoarthritis may be associated with severe posterior glenoid bone loss and glenoid retroversion. Treatment with total shoulder arthroplasty and autologous bone graft obtained from the humeral head has been infrequently reported in the peer-reviewed literature. The clinical and radiographic results of primary total shoulder replacement with an all-polyethylene glenoid component and autologous humeral head graft augmentation performed by a single surgeon in thirteen consecutive patients were evaluated. Twelve of the thirteen patients were followed for a minimum of two years (average, fifty-three months; range, twenty-six to 110 months). The average glenoid retroversion on preoperative computed tomography (CT) scans was 44° (range, 20° to 65°). Based on the Walch classification of pathologic glenoid morphology, nine glenoids were B2 and three were type C. All patients had an intact cuff at the time of surgery. At the time of the last follow up, ten of the twelve patients had graft incorporation without any resorbtion and two had minor bone graft resorption. Broken screws occurred in two of these ten cases. Two patients, both of whom required revision surgery, had failure of fixation and of graft incorporation; one of these failures was due to early postoperative trauma and the other, to Propionibacterium acnes infection. The early and midterm results of total shoulder arthroplasty with autogenous bone graft demonstrated substantial clinical and radiographic improvement in most cases.