Distal clavicle autograft: a relatively simple solution for glenoid bone loss at the time of revision reverse...

Glenoid bone loss is commonly encountered at the time of revision reverse shoulder arthroplasty (rTSA). The ipsilateral distal clavicle has been considered as one possible source of autograft if needed at the time of revision rTSA. The purpose of this study was to determine the outcome of ipsilateral distal clavicle autograft (IDCA) at the time of revision rTSA with particular attention to survival of the glenoid baseplate.

Between 2017 and 2023, 20 consecutive revision rTSAs were performed at a single institution using IDCA augmentation of glenoid defects. The mean age at the time of surgery was 74 ± 12 years. Failed prostheses revised included 13 anatomic total shoulder arthroplasties and 7 failed rTSAs. According to the Kocsis classification, pre-operative bone loss was considered stage 2 in 12 shoulders and stage 3 in 8 shoulders. Intraoperatively, 15 patients had central bone defects and 5 patients had combined bone loss using Antuña classification. Clinical assessment was performed pre-operatively and post-operatively for pain, subjective, and objective scores. Radiographic evaluation analyzed the position of the glenoid component as well as radiographic evidence of graft incorporation and loosening. The mean follow-up time was 44 ± 12 months.

Mean visual analog scale scores for pain decreased 7 pre-operatively to 1 at most recent follow-up (P < .001). Active elevation and external rotation were improved as well (active elevation = 89° pre-operatively vs. 111° at most recent follow-up [P < .01]; external rotation = 22 pre-operatively degrees vs. 32° at most recent follow-up [P < .01]). Constant scores, American Shoulder and Elbow Surgeons scores, and subjective shoulder values also improved from pre-operatively to most recent (34 points vs. 58 points, P < .001 for Constant scores; 31 points vs. 65 points, P < .001 for American Shoulder and Elbow Surgeons scores; 30% vs. 64% for subjective shoulder values, P < .001). Two revisions were performed for recurrence of infection. One additional shoulder underwent irrigation and débridement with implant retention and one shoulder underwent closed reduction of a dislocation. For the 18 shoulders with no re-revision for infection, IDCA appeared radiographically incorporated, and there was no evidence of glenoid loosening.

At mid-term follow-up, IDCA provided a reliable option for moderate glenoid bone loss encountered at the time of revision rTSA. A major benefit of IDCA is availability from the same surgical site of the revision procedure, even if pre-operative assessment underestimated bone loss. These results need to be confirmed in a larger sample size and with longer follow-up.