Structural glenoid grafting during primary reverse total shoulder arthroplasty using humeral head autograft

Abstract

Large glenoid bone defects in the setting of glenohumeral arthritis can present a challenge to the shoulder arthroplasty surgeon. The results of large structural autografting at the time of reverse total shoulder arthroplasty (RTSA) are relatively unknown. This retrospective case series describes the clinical and radiographic results of large structural autografting from the humeral head to the glenoid during primary RTSA. Of 17 patients who met inclusion criteria, 14 (82% follow-up) were evaluated postoperatively at a mean of 2.6 years (range, 2.0-5.4 years). Mean inclination correction was 19° ± 12° (range, 3°-35°). Complications occurred in 3 patients, including 1 transient brachial plexus palsy, 1 loose baseplate, and 1 dislocation treated with closed reduction. Radiographic images showed 100% of grafts incorporated. Active forward elevation improved from 80° ± 40° to 130° ± 49° (P = .028). The visual analog scale score for pain improved from 8.1 ± 1.3 to 2.5 ± 3.1 (P = .005). The Simple Shoulder Test improved from 1.8 ± 1.1 to 6.5 ± 4 (P = .012). The American Shoulder and Elbow Surgeons score improved from 22 ± 10 to 66 ± 25 (P = .012). All patients (100%) were satisfied, and all patients (93%) but 1 stated that they would undergo the procedure again if given the chance. RTSA incorporating structural grafting of the glenoid with humeral head autograft results in significant improvements in active forward elevation, pain, and function, with a low complication rate. This technique can reliably be used to achieve correction of large (up to 35°) glenoid defects with a 93% chance of baseplate survival and a 100% chance of graft incorporation in the short-term.