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Tips
Glenoid Bone Loss in Reverse Shoulder Arthroplasty Treated with Bone Graft Techniques
Author’s Disclosure Statement: Dr. Norris reports that he is a prosthetic designer and consultant for Wright Medical.
Dr. Norris is the Fellowship Director for the Shoulder and Elbow fellowship; and an Orthopaedic Surgeon, Department of Orthopaedics, California Pacific Medical Center, San Francisco, California.
Address correspondence to: Tom R. Norris, MD, California Pacific Medical Center, 3838 California Street, Suite 715, San Francisco, CA 94118 (tel, 415-722-6835; fax, 415-928-1035; email, trnorris@tomnorris.com).
Am J Orthop. 2018;47(3). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.
Tom R. Norris, MD . Glenoid Bone Loss in Reverse Shoulder Arthroplasty Treated with Bone Graft Techniques. Am J Orthop. March 23, 2018
TAKE-HOME POINTS
Glenoid deficiencies that occur from dysplasia, arthritis, or polyethylene osteolysis may be successfully addressed with bone grafting techniques and reverse shoulder arthroplasty.
The intact humeral head in a primary case is ideal graft to be shaped to fit the glenoid deficits.
The reverse shoulder with a long post base plate that is fixed securely to the native scapula is the author’s preferred technique.
As the native humeral head is not available in revision cases, the tricortical iliac crest bone graft may be fixed as a structural graft in 1-stage.
When the scapular walls are deficient and medial fixation is not secure, 2 stages 4 months to 6 months apart will be necessary before loading the construct.
References
ABSTRACT
The reverse shoulder arthroplasty facilitates surgical treatment of primary and revision shoulder with rotator cuff and bone deficiencies. Wear pattern classifications and a logical treatment approach for glenoid bone loss enable the surgeon to address a difficult series of problems in the reconstructions where the glenoid might not otherwise be able to support the implants. Bone grafting using the native humeral head in primary cases, and in revision cases, iliac crest are the most reliable sources for structural grafts for the worn or deficient glenoid vault.
