Reconstruction of large glenoid bone defects with graft and extended caged base plate yields positive mid-term results.

Abstract

Background This retrospective study assessed postoperative functional outcomes and radiographic graft integration following reverse total shoulder arthroplasty (rTSA) and glenoid reconstruction using computed navigation. Methods A case series of 14 patients underwent rTSA with an augmented glenoid baseplate using autograft or allograft. All patients had preoperative computed tomography scanning to assess glenoid defects and repeat scans at a minimum of 12 months to assess graft integration. Outcome measures were collected, consisting of the Oxford Shoulder Score (OSS), visual analogue pain scale (VAS), and range of motion figures at a minimum 12-month follow-up. Results This study included 14 patients (13 females, 1 male) with a median age of 74 (range: 58-86) years, a median body mass index of 29 (range: 18-35), and a median American Society of Anesthesiologists physical status classification system of 2 (range: 1-3). Ten were primary replacements, and 4 were revisions. Humeral head autograft was used for 6 patients, and femoral head allograft in 8 patients. All patients demonstrated graft integration on computed tomography at a median of 15 months (range: 11-42 months). The outcome measures (OSS, VAS, and range of motion) revealed overall improvement in functional outcomes. Median OSS improved from 21 (range: 7-34) preoperatively to 45 (range: 12-49), median VAS improved from 8 (range: 5-10) to 0 (range: 0-8), median lateral abduction improved from 60 to 90°, and median forward flexion 80 to 140°. These improvements were significant. Glenoid version correction, although not significant, improved from a median of 24° retroversion to 9° retroversion. Navigation was performed in all patients except 2, one by choice in a primary rTSA and the other due to intraoperative coracoid fracture during a revision case. Conclusion This study demonstrated an effective solution for managing complex glenoid defects in rTSA with excellent radiographic and functional outcomes.