Glenoid Bone Grafting During Primary Reverse Shoulder Arthroplasty: A Learning-Curve Analysis

Area of Science:

• Orthopedic Surgery
• Shoulder and Elbow Surgery

Background:

• Reverse shoulder arthroplasty (RSA) with glenoid bone grafting using humeral head autograft effectively treats severe glenoid bone loss.
• RSA with bone grafting presents unique technical challenges and higher complication rates compared to standard RSA.
• The learning curve and proficiency benchmarks for RSA with bone grafting remain undefined.

Purpose of the Study:

• To define the learning curve for fellowship-trained surgeons performing RSA with humeral head bone grafting.
• To assess the relationship between surgical experience and operative time, patient outcomes, and complication rates.

Main Methods:

• Analysis of 32 patients undergoing primary RSA with bone grafting between November 2018 and February 2022.
• Utilized linear regression and cumulative sum (CUSUM) analysis of operative times to determine the learning curve.
• Compared perioperative data, functional outcomes (range of motion, ASES, SSV), and pain scores (VAS) between learning and proficiency phases.

Main Results:

• A total of 32 patients (mean age 68 years) were analyzed with a mean follow-up of 28 months.
• Operative time showed a linear decrease, with CUSUM analysis indicating a learning curve of 14 patients.
• No significant differences in range of motion, ASES, or SSV scores were found between the learning and proficiency phases; VAS pain scores improved in the proficiency phase.

Conclusions:

• Surgical proficiency in RSA with humeral head bone grafting is estimated at 14 cases, evidenced by a decrease in operative time.
• Achieving proficiency did not compromise postoperative outcomes or complication rates.
• This study provides a benchmark for surgical training and evaluation in this complex procedure.