Survivorship of autologous structural bone graft at a minimum of 2 years when used to address significant glenoid bone loss in primary and revision shoulder arthroplasty: a computed tomographic and clinical review

Singh, Jagwant; Odak, Saurabh; Neelakandan, Karthik; Walton, Michael; Monga, Puneet; Bale, Steve; Trail, IA

doi:10.1016/j.jse.2020.06.015

Cited by 16 publications

(12 citation statements)

References 30 publications

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“…However, a systematic review by Malahias et al still reported a rate of radiographic non-union at 5.2% [37]. In addition, it is important to note that despite evidence of radiological union, true integration of the graft is rarely complete [38], as confirmed in the present study. Given this finding, the authors recommend that as much of the bony defect as possible should be covered by the graft in order to maximize the surface of contact and, consequently, the potential of healing.…”

Section: Discussionsupporting

confidence: 71%

“…The use of a central screw baseplate to fix massive grafts is debatable. It is thought that screws do not provide bone ingrowth possibilities like it is the case around a central peg [38]. The minimal central peg length proposed in the literature that should be inserted in the native bone stock to avoid loosening varies between 8 to 10 mm [21,39].…”

Section: Discussionmentioning

confidence: 99%

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Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Nabergoj

Neyton

Bothorel

et al. 2021

JCM

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There are different techniques to address severe glenoid erosion during reverse shoulder arthroplasty (RSA). This study assessed the clinical and radiological outcomes of RSA with combined bony and metallic augment (BMA) glenoid reconstruction compared to bony augmentation (BA) alone. A review of patients who underwent RSA with severe glenoid bone loss requiring reconstruction from January 2017 to January 2019 was performed. Patients were divided into two groups: BMA versus BA alone. Clinical outcome measurements included two years postoperative ROM, Constant score, subjective shoulder value (SSV), and the American Shoulder and Elbow Surgeons Shoulder (ASES) score. Radiological outcomes included radiographic evidence of scapular complications and graft incorporation. The BMA group had significantly different glenoid morphology (p < 0.001) and greater bone loss thickness than the BA group (16.3 ± 3.8 mm vs. 12.0 ± 0.0 mm, p = 0.020). Both groups had significantly improved ROM (anterior forward flexion and external rotation) and clinical scores (Constant, SSV and ASES scores) at 2 years. Greater improvement was observed in the BMA group in terms of anterior forward flexion (86.3° ± 27.9° vs. 43.8° ± 25.6°, p = 0.013) and Constant score (56.6 ± 10.1 vs. 38.3 ± 16.7, p = 0.021). The BA group demonstrated greater functional and clinical improvements with higher postoperative active external rotation and ASES results (active external rotation, 49.4° ± 17.0° vs. 29.4° ± 14.7°, p = 0.017; ASES, 89.1 ± 11.3 vs. 76.8 ± 11.0, p = 0.045). The combination use of bone graft and metallic augments in severe glenoid bone loss during RSA is safe and effective and can be considered in cases of severe glenoid bone loss where bone graft alone may be insufficient.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Nabergoj

Neyton

Bothorel

et al. 2021

JCM

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“…a further limitation of this review was that eight of the 19 included studies included a mix of revision and primary arthroplasty cohorts. [52][53][54][55][56][57][58][59] we are of the opinion that these represent distinct entities with regard to the associated outcomes. Furthermore, a high-quality statistical analysis of large volumes of continuous variable data across subgroups necessitates the use of Forest plots as well as an analysis of heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

Management of glenoid bone loss in primary reverse shoulder arthroplasty

Wilcox

Campbell

Low

et al. 2022

The Bone & Joint Journal

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Aims Rates of reverse total shoulder arthroplasty (rTSA) continue to grow. Glenoid bone loss and deformity remains a technical challenge to the surgeon and may reduce improvements in patients’ outcomes. However, there is no consensus as to the optimal surgical technique to best reconstruct these patients’ anatomy. This review aims to compare the outcomes of glenoid bone grafting versus augmented glenoid prostheses in the management of glenoid bone loss in primary reverse total shoulder arthroplasty. Methods This systematic review and meta-analysis evaluated study-level data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We performed searches of Medline (Ovid), Embase (Ovid), and PubMed from their dates of inception to January 2022. From included studies, we analyzed data for preoperative and postoperative range of motion (ROM), patient-reported functional outcomes, and complication rates. Results A total of 13 studies (919 shoulders) were included in the analysis. The mean age of patients at initial evaluation was 72.2 years (42 to 87), with a mean follow-up time of 40.7 months (24 to 120). Nine studies with 292 rTSAs evaluated the use of bone graft and five studies with 627 rTSAs evaluated the use of augmented glenoid baseplates. One study was analyzed in both groups. Both techniques demonstrated improvement in patient-reported outcome measures and ROM assessment, with augmented prostheses outperforming bone grafting on improvements in the American Shoulder and Elbow Surgeons Score. There was a higher complication rate (8.9% vs 3.5%; p < 0.001) and revision rate among the bone grafting group compared with the patients who were treated with augmented prostheses (2.4% vs 0.6%; p = 0.022). Conclusion This review provides strong evidence that both bone graft and augmented glenoid baseplate techniques to address glenoid bone loss give excellent ROM and functional outcomes in primary rTSA. The use of augmented base plates may confer fewer complications and revisions. Cite this article: Bone Joint J 2022;104-B(12):1334–1342.

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“…A newer implant made of porous titanium in combination with an autograft may provide a solution. While early results are promising both clinically and with regard to integration of the graft, 29 long-term stability remains a concern. Although the composite is initially stabilized by impaction and screw fixation, it is not clear whether this fixation is sufficient or remains in place until integration is complete.…”

Section: Discussionmentioning

confidence: 99%

“…The techniques used for harvesting bone graft have been described previously. 29 The salient features of the techniques are described below.…”

Section: Methodsmentioning

confidence: 99%

A prospective radiostereometric analysis of the stability of a metal-backed glenoid component/autograft composite in reverse shoulder arthroplasty

Cunningham,

Walton,

Bale

et al. 2023

Bone Joint J

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AimsReverse total shoulder arthroplasty (rTSA) can be used in complex cases when the glenoid requires reconstruction. In this study, a baseplate with composite bone autograft and a central trabecular titanium peg was implanted, and its migration was assessed for two years postoperatively using radiostereometric analysis (RSA).MethodsA total of 14 patients who underwent a rTSA with an autograft consented to participate. Of these, 11 had a primary rTSA using humeral head autograft and three had a revision rTSA with autograft harvested from the iliac crest. The mean age of the patients was 66 years (39 to 81). Tantalum beads were implanted in the scapula around the glenoid. RSA imaging (stereographic radiographs) was undertaken immediately postoperatively and at three, six, 12, and 24 months. Analysis was completed using model-based RSA software. Outcomes were collected preoperatively and at two years postoperatively, including the Oxford Shoulder Score, the American Shoulder and Elbow Score, and a visual analogue score for pain. A Constant score was also obtained for the assessment of strength and range of motion.ResultsRSA analysis showed a small increase in all translation and rotational values up to six months postoperatively, consistent with settling of the implant. The mean values plateaued by 12 months, with no evidence of further migration. In four patients, there was significant variation outside the mean, which corresponded to postoperative complications. There was a significant improvement in the clinical and patient-reported outcomes from the preoperative values to those at two years postoperatively (p < 0.001).ConclusionThese findings show, using RSA, that a glenoid baseplate composite of a trabecular titanium peg with autograft stabilizes within the glenoid about 12 months after surgery, and reinforce findings from a previous study of this implant/graft with CT scans at two years postoperatively, indicating that this type of structural composite results in sound early fixation.Cite this article: Bone Joint J 2023;105-B(8):912–919.

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Survivorship of autologous structural bone graft at a minimum of 2 years when used to address significant glenoid bone loss in primary and revision shoulder arthroplasty: a computed tomographic and clinical review

Cited by 16 publications

References 30 publications

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Reverse Shoulder Arthroplasty with Bony and Metallic versus Standard Bony Reconstruction for Severe Glenoid Bone Loss. A Retrospective Comparative Cohort Study

Management of glenoid bone loss in primary reverse shoulder arthroplasty

A prospective radiostereometric analysis of the stability of a metal-backed glenoid component/autograft composite in reverse shoulder arthroplasty

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