Bone grafting for glenoid deficiency in total shoulder replacement

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Radiology

Background:

• Segmental glenoid wear is a significant challenge in total shoulder arthroplasty.
• Restoring glenoid bone stock and joint congruity is crucial for successful outcomes.
• Arthritis associated with shoulder instability presents unique reconstructive needs.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of glenoid bone grafting for segmental glenoid wear.
• To assess the efficacy of autogenous humeral head grafts in total shoulder arthroplasty.
• To determine the long-term success of this technique in patients with osteoarthritis and instability.

Main Methods:

• Twenty-eight patients underwent glenoid bone grafting as part of total shoulder arthroplasty.
• Autogenous humeral head grafts were utilized in 27 patients, with fixation via 3.5-mm cortical screws in 25.
• Follow-up averaged 5.3 years, including clinical assessment (pain, range of motion) and radiographic evaluation (lucencies).

Main Results:

• Postoperative pain was minimal to moderate in all patients.
• Average range of motion: 126° abduction, 39° external rotation, T12 internal rotation.
• Neer's ratings: 13 excellent, 10 satisfactory, 5 unsatisfactory. Radiographically, 4/28 glenoids showed complete lucencies, but only 2 were symptomatic.

Conclusions:

• Glenoid bone grafting with autogenous humeral head grafts is a viable technique for segmental glenoid defects.
• The procedure demonstrates comparable clinical and radiographic results to standard total shoulder arthroplasty.
• This method effectively restores glenoid bone and joint alignment, improving functional outcomes.