Clinical and radiographic outcomes with a posteriorly augmented glenoid for Walch B2, B3, and C glenoids in reverse total shoulder arthroplasty

Virk, Mandeep S.; Yip, Michael C.; Liuzza, Lindsey G.; Abdelshahed, Mina; Paoli, Albit; Grey, Sean G.; Wright, Thomas W.; Flurin, Pierre-Henri; Roche, Christopher P.

doi:10.1016/j.jse.2019.09.031

Cited by 67 publications

(25 citation statements)

References 37 publications

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“…The limited current body of evidence supporting the use of metallic augmented baseplates is based on small series using 1 particular component. 10,19,28,31 failure. The subset of patients with Walch type B2, B3, and C glenoids in our series performed very similarly to the patients of Virk et al regarding improvement in range of motion and functional outcome scores.…”

Section: Discussionmentioning

confidence: 99%

“…8,11 Augmented baseplates have also recently been used to address glenoid deformity, which potentially can avoid some of the complications encountered with a structural bone graft. 10,28 The purpose of this study was to evaluate the early clinical and radiographic outcomes of an augmented baseplate during primary RSA in patients with significant glenoid deformity. We also sought to evaluate the early complications associated with augmented baseplates.…”

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confidence: 99%

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Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Kirsch

Patel

Singh

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Glenoid deformity is commonly encountered in patients undergoing reverse shoulder arthroplasty (RSA). Augmented baseplates can correct glenoid deformity while potentially avoiding certain complications encountered with structural bone graft. Limited evidence exists to support the use of metallic augmented baseplates in RSA. Methods: We performed a retrospective review to identify all patients treated with an augmented baseplate during primary RSA with a minimum of 1 year of clinical and radiographic follow-up. Preoperative radiographs and advanced imaging were used to determine glenoid morphology and deformity. Postoperative radiographs were used to evaluate for deformity correction, radiographic complications, and early baseplate loosening or failure. Prospectively collected clinical data and patient-reported outcome scores were determined. Results: Primary RSA was performed with an augmented baseplate in 44 patients (mean age, 72 AE 6 years; 15 half-wedge and 29 fullwedge augmentations). Glenoid retroversion was significantly improved for the entire cohort (P ¼ .001). Among the 22 patients with either Walch type B2, B3, or C glenoid morphology, glenoid version improved from 28 AE 8 to 16 AE 8 (P ¼ .001). Glenoid inclination, as determined by the b angle, was significantly improved for the entire cohort (P < .001). Among the 18 patients with Favard type E2 or E3 glenoid morphology, glenoid inclination improved from 67 AE 7 to 81 AE 8 (P < .001). Postoperative range of motion and functional outcome scores including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Single Assessment Numeric Evaluation score, and visual analog scale score for pain significantly improved within the entire cohort (P < .05). No patients had evidence of baseplate loosening or failure of the glenoid component. Acromial stress fractures developed in 5 patients (11.4%), and 2 patients (4.5%) underwent a reoperation unrelated to the glenoid component. Discussion and conclusion: Primary RSA with an augmented baseplate results in excellent short-term clinical outcomes and significant deformity correction in patients with advanced glenoid deformity. There were no complications related to the augmented baseplate or glenoid component. The rate of acromial stress fractures appears higher than typically reported and warrants further investigation.This study was approved by the Thomas Jefferson University Institutional Review Board (no. 19D.732).

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Kirsch

Patel

Singh

et al. 2021

Journal of Shoulder and Elbow Surgery

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“…Different treatment options have been suggested for anatomic hemi-or total shoulder arthroplasty. Asymmetric reaming, posterior glenoid bone grafting, or posteriorly augmented glenoid components have been used, but peak stress on the posterior glenoid edge still leads to increased failure rates, mainly due to early glenoid loosening or dislocation [15,[26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Reverse total shoulder arthroplasty in patients with type B2, B3, and type C glenoids: comparable clinical outcome to patients without compromised glenoid bone stock—a matched pair analysis

Loucas

Kriechling

Loucas

et al. 2021

Arch Orthop Trauma Surg

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Background Primarily posterior bone deficient (dysplastic) (Walch type C) or secondarily eroded (Walch type B2 or B3) glenoids represent a surgical challenge for shoulder arthroplasty. Due to the posteriorly static decentered head, reverse total shoulder arthroplasty (RTSA) is often considered as the treatment of choice. The purpose of this study is to report the clinical and radiographic outcomes, complications and reoperations of RTSA for posteriorly deficient glenoids. Materials and methods All patients who underwent RTSA for osteoarthritis secondary to underlying glenoid deficiency (Walch type B2, B3 and C) between 2005 and 2018 (study group), were identified from our institutional shoulder arthroplasty database and gender- and age-matched to a cohort of patients with normal glenoid bone stock (control group). Longitudinal pre- and postoperative clinical [Constant–Murley (CS) score, Subjective Shoulder Value (SSV)] and radiographic outcomes were assessed. Results We included 188 patients (94 in each group). The median follow-up was 43 ± 26 (24–144) months in the study group and 59 ± 32 (24–124) months in the control group. The glenoid deficiency was addressed by using glenoid bone reconstruction. The surgical site complication and revision rate of RTSA in patients with bony deficient glenoids were 17% and 7%. Although glenoid loosening was slightly higher in the study group (5 vs. 2), overall no significant differences were found between the study and control groups in satisfaction scores, preoperative and postoperative absolute and relative Constant scores, complication and revision rates, respectively. Conclusion Reverse total shoulder arthroplasty (RTSA) seems to be a valuable treatment option for patients with primary (dysplasia) or secondary (wear) posterior glenoid deficiency. Although severe glenoid bone loss seems to be a risk factor for glenoid component failure, the overall complication and revision rates as well as clinical and radiographic outcome are comparable to RTSA in patients without compromised glenoid bone stock. Level of evidence Level III: case–control study

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“…However, the available literature is limited, and only reports the short to mid-term outcome of augmented implants. [7][8][9][10] Laboratory mechanical testing of glenoid bone deficiency in reverse total shoulder arthroplasty demonstrates compromised implant stability in the presence of significant glenoid bone deficiency with traditional implants. [11][12][13][14] Other studies have examined the biomechanics of specific augmented baseplate designs, typically designed to compensate for small glenoid defects.…”

Section: Introductionmentioning

confidence: 99%

Reverse Total Shoulder Arthroplasty Baseplate Stability in Superior Bone Loss With Augmented Implant

Martin

Duquin

Ehrensberger

2021

Journal of Shoulder and Elbow Arthroplasty

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Background Glenoid bone loss is commonly encountered in cases of rotator cuff tear arthropathy and can create challenges during reverse shoulder arthroplasty. In this study, we sought to investigate the biomechanical properties of a new treatment option for superior glenoid defect, an augmented reverse total shoulder baseplate. Methods Three conditions were examined: non-augmented baseplate without defect, non-augmented baseplate with defect, and augmented baseplate with defect. The augmented baseplates included a 30-degree half wedge which also matched the created superior defect. The samples were cyclically loaded at a 60° simulated abduction angle to mimic baseplate loosening. The migration and micromotion of the baseplate were measured on the superior edge using a 3D Digital Image Correlation System. Results The migration measured in the augmented baseplate showed no significant difference when compared to the no defect or defect cases. In terms of micromotion, the augmented baseplate showed values that were between the micromotions reported for the no defect and defect conditions, but not by a statistically significant amount. Conclusion This study provides biomechanical evidence that augmented baseplates can reduce the amount of micromotion experienced by the RSA construct in the presence of significant superior glenoid bone deficiency, but do not fully restore stability to that of a full contact non-augmented baseplate.

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Clinical and radiographic outcomes with a posteriorly augmented glenoid for Walch B2, B3, and C glenoids in reverse total shoulder arthroplasty

Cited by 67 publications

References 37 publications

Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Early clinical and radiographic outcomes of an augmented baseplate in reverse shoulder arthroplasty for glenohumeral arthritis with glenoid deformity

Reverse total shoulder arthroplasty in patients with type B2, B3, and type C glenoids: comparable clinical outcome to patients without compromised glenoid bone stock—a matched pair analysis

Reverse Total Shoulder Arthroplasty Baseplate Stability in Superior Bone Loss With Augmented Implant

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