Structural glenoid allograft reconstruction during reverse total shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Science

Background:

• Large glenoid defects pose significant challenges in primary and revision reverse total shoulder arthroplasty (RTSA).
• Limited availability of humeral head autograft for bone reconstruction complicates these procedures.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of RTSA utilizing structural allograft for the reconstruction of large glenoid defects.

Main Methods:

• A cohort of 22 patients undergoing primary or revision RTSA with structural glenoid allografting was retrospectively reviewed.
• Clinical follow-up averaged 2.8 years, with radiographic follow-up averaging at least 1 year for a majority of patients.
• Outcomes assessed included functional scores, range of motion, radiographic correction, graft incorporation, and complication rates.

Main Results:

• Significant improvements were observed in Simple Shoulder Test and American Shoulder and Elbow Surgeons scores, alongside increased active forward elevation.
• Radiographic analysis demonstrated successful coronal-plane deformity correction.
• Complete radiographic incorporation of the allograft was achieved in 82% of patients with sufficient follow-up; 2 patients experienced acromial nonunion and 2 had baseplate loosening/migration without requiring revision surgery.

Conclusions:

• RTSA with structural allograft reconstruction effectively restores glenoid anatomy in severe defects.
• High rates of bony incorporation and low rates of glenoid loosening or revision indicate structural allograft is a valuable alternative to autograft in RTSA, avoiding graft-site morbidity.