Yoke procedure as a salvage treatment option for failed reverse total shoulder arthroplasty with irreconstructible glenoid

Abstract

Glenoid bone loss is a known challenge in primary and revision reverse total shoulder arthroplasty. In severe deficiency, even placing the baseplate in alternative centerline or using an augmented baseplate may be insufficient. This study reports on the use of a soft tissue resurfacing technique using Achilles tendon allograft, coined Yoke procedure, for salvage treatment of glenoid deficient shoulder requiring reconstruction. All patients who underwent the Yoke procedure between 2014 and 2020 by a single surgeon at a single academic center were identified and had their charts retrospectively reviewed. Demographics and surgical information were recorded. Preoperative X-rays and 3D-CT scans were reviewed to classify patient glenoid types, evaluate glenoid medialization, and measure shoulder angles. Preoperative and postoperative range of motion (ROM) and patient-reported outcome scores were evaluated, including anterior elevation (AE), external rotation (ER), internal rotation (IR), Visual Analog Scale (VAS), Subjective Shoulder Score (SSV), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) scores. Postoperative radiographs and follow-up notes were reviewed to evaluate postoperative complication profiles at 1 year. Seven patients with median age of 69 years (range 54-77) underwent Yoke procedure and had median 12-month follow-up (range 9 - 56). All patients were female and had median of 2 prior shoulder surgeries (range 0-13). Of all the patients, the most common comorbidity was osteoporosis (6) followed by rheumatoid arthritis (3). Of the 5 patients who had previous arthroplasty, the most common indications were baseplate failure (4), followed by instability (3) and infection (3). Median VAS score improved from 8 (range 3-9) to 2 (range 1-4). Median SST improved from 8% (range 0-42%) to 33% (range 17-83%). Median ASES score improved from 15 (range 5-38) to 52 (range 40-78). Median AE and ER improved from 20° (range 0°- 75°) to 100° (range 40°- 145°) and 10° (range 0°- 20°) to 20° (range 0°- 55°), respectively. There was no change in median IR. As of last follow-up, one patient reported postoperative complications of anterior superior implant escape, heterotopic ossification, and scapular notching. The Yoke procedure is a promising salvage treatment that can offer patients consistent pain reduction and moderate functional improvements at short-term follow-up. In the setting of poor bone quality and severe glenoid deficiency, glenoid baseplate implantation may not be absolutely necessary for a pain-relieving, functionally acceptable outcome.