Novel Solution for Massive Glenoid Defects in Shoulder Arthroplasty: A Patient-Specific Glenoid Vault Reconstruction...

Complex glenoid deformities present the most difficult challenges in shoulder arthroplasty. These deformities may be caused by severe degenerative or congenital deformity, posttraumatic anatomy, tumor, or, in most cases, bone loss after glenoid failure in anatomical total shoulder arthroplasty. Methods of treating severe bone loss have included inlay and onlay bone-graft options with augmented fixation and, in severe cases, salvage hemiarthroplasty with limited goal expectations. Unfortunately, none of these methods has provided consistently satisfactory reproducible results. In fact, each has had high rates of failure and complications. Borrowing from hip and knee arthroplasty surgeons' experience in using CAD/CAM (computer-aided design/computer-aided manufacturing) patient-specific implants to fill significant bony defects, Dr. D. M. Dines developed a glenoid vault reconstruction system (VRS) in conjunction with the Comprehensive Shoulder Arthroplasty System (Zimmer Biomet) to treat severe glenoid bone deficiency. The VRS is patient-specific; each case involves making a preoperative plan based on 3-dimensional reconstruction of a 2-dimensional computed tomography scan. The patient-specific implant and instrumentation that are created are used to reconstruct the deformed glenoid in an anatomical position without the need for additional bone graft. In this article, we describe the implant and its indications, technical aspects of production, and surgical technique.