Der Orthopäde

, Volume 46, Issue 12, pp 1045–1054 | Cite as

“Shaped” humeral head autograft reverse shoulder arthroplasty

Treatment for primary glenohumeral osteoarthritis with significant posterior glenoid bone loss (B2, B3, and C type)



Posterior glenoid bone loss in primary glenohumeral osteoarthritis (GHOA) presents a challenge when considering replacement surgery. Results with anatomic shoulder arthroplasty are unpredictable due to posterior humeral instability and limited bone stock for glenoid component fixation.


To describe and evaluate the results of a “shaped” humeral head autograft with reverse shoulder arthroplasty (RSA) for the treatment of primary GHOA with significant posterior glenoid bone loss and an intact, functional rotator cuff.

Materials and methods

We retrospectively reviewed 29 “shaped” humeral head autografts with RSA for the treatment of GHOA with B2 (= 16), B3 (= 10), or C (= 3) glenoid morphology based on the Walch classification system. Average glenoid retroversion was 32.3°. Humeral head autografts were “shaped” to match each patient’s individual glenoid morphology. Functional outcome scores, range of motion, strength, and radiographic outcomes were evaluated.


At average follow-up of 34.6 months (range 23.7–88.9 months), significant improvements were seen in all functional outcome scores, ranges of motion, and strength (p <0.01). No recurrent instability or glenoid fixation failure occurred. Two complications (1 superficial and 1 deep infection) in 2 patients were identified. All autografts incorporated without radiographic evidence of loosening. Scapular notching was observed in 8 shoulders. No negative correlations were identified with glenoid morphology.


“Shaped” humeral head autograft with RSA for the treatment of primary GHOA with significant posterior glenoid bone loss is associated with excellent clinical and radiographic outcomes and a low complication profile at short- to mid-term follow-up.


Shoulder prosthesis Complications Autografts Glenoid retroversion Outcomes 





Active range of motion


American Shoulder and Elbow Surgeons


Bony increased offset reverse shoulder arthroplasty


Computed tomography


External rotation with the arm held at 0° of abduction


Forward flexion


Functional outcome scores


Glenohumeral osteoarthritis


Internal rotation


Institutional review board


Posterior glenoid bone loss


Reverse shoulder arthroplasty


Simple Assessment Numeric Evaluation


Total shoulder arthroplasty


Visual analog scale

Inverse Schulterendoprothese mit individuellem autologem Glenoidaufbau

Therapie für primäre Omarthrose mit deutlichem posteriorem Glenoiddefekt (Typ B2, B3 und C)



Posteriore Glenoiddefekte bei der primären Omarthrose stellen für die endoprothetische Versorgung eine Herausforderung dar. Die Ergebnisse sind mit anatomischen Endoprothesen wegen der Dezentrierung und oft grenzwertigen Möglichkeit der Fixierung einer Glenoidkomponente nicht vorhersagbar.

Ziel der Arbeit

Operationstechnik und mittelfristige Ergebnisse nach operativer Behandlung einer Omarthrose mit signifikantem Knochendefekt bei intakter Rotatorenmanschette mittels inverser Schultertotalendoprothese (TEP) und autologem Glenoidaufbau werden beschrieben.

Material und Methoden

Es wurden 29 Fälle nach Implantation einer inversen TEP und Glenoidaufbau mittels individuell angepasstem autologem Knochenblock retrospektiv ausgewertet, davon 16 Fälle mit B2-, 10 mit B3-Deformität und 3 mit einem C‑Typ nach Walch-Klassifikation. Die durchschnittlich gemessene Retroversion betrug 32,3°. Die autologen Knochenblöcke wurden an die individuelle Glenoidmorphologie angepasst. Funktionelles Ergebnis, Bewegungsumfang, Kraft und Röntgenbefund wurden erhoben.


Nach durchschnittlich 34,6 Monaten (23,7–88,9 Monate) fand sich eine signifikante (p < 0,01) Verbesserung in allen erhobenen Parametern (Bewegungsumfang, Kraft und Score). Weder eine Instabilität noch eine Lockerung wurden festgestellt. Zwei Komplikationen (eine oberflächliche und eine tiefe Infektion) traten auf. Bei allen autologen Transplantaten lag röntgenologisch ein Einbau ohne Anhalt für eine Lockerung der Basisplatte vor. Ein Skapula-Notching zeigte sich in 8 Fällen. Es ließ sich keine Korrelation des klinischen Ergebnisses mit der Schwere des Glenoiddefekts bzw. der präoperativ vorhandenen Morphologie herstellen.


Mit individuell angepasstem autologem Glenoidaufbau und inverser TEP können kurz- bis mittelfristig auch in Fällen mit ausgeprägtem Knochendefekt bei Omarthrose ausgezeichnete klinische und radiologische Ergebnisse bei niedriger Komplikationsrate erzielt werden.


Schulterendoprothese Komplikationen Autotransplantat Glenoidretroversion Ergebnisse 



Funding used for management of the database was provided by Tornier, Inc. User Friendly Custom Software, Inc., the hosting company of the database, was paid an annual fee directly from Tornier, Inc. No other funding was received for this study.

Compliance with ethical guidelines

Conflict of interest

S. Harmsen, D. Casagrande, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article and declare that they have no competing interests. T. Norris received royalties and consultant payments from Tornier, Inc., which is related to the subject of this work. Dr. Norris also received financial support from Tornier, Inc. for the database used in the study.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

Institutional Review Board approval for this study was provided by the California Pacific Medical Research Institute, study number 27.007.


  1. 1.
    Walch G, Boulahia A, Boileau P, Kempf J‑F, Aequalis Group (1999) Primary glenohumeral osteoarthritis: clnical and radiographic classification. Shoulder Arthroplast 64:46–52Google Scholar
  2. 2.
    Bercik MJ, Kruse K II, Yalizis M, Gauci M‑O, Chaoui J, Walch G (2016) A modification to the Walch classification of the glenoid in primary glenohumeral osteoarthritis using three-dimensional imaging. J Shoulder Elbow Surg 25:1601–1606CrossRefPubMedGoogle Scholar
  3. 3.
    Boileau P, Avidor C, Krishnan SG, Walch G, Kempf J‑F, Mole D (2002) Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elbow Surg 11:351–359CrossRefPubMedGoogle Scholar
  4. 4.
    Boileau P, Moineau G, Roussanne Y, O’Shea K (2011) Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res 469:2558–2567CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three-and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Jt Surg Br 89:516–520CrossRefGoogle Scholar
  6. 6.
    Clavert P, Millett PJ, Warner JJ (2007) Glenoid resurfacing: what are the limits to asymmetric reaming for posterior erosion? J Shoulder Elbow Surg 16:843–848CrossRefPubMedGoogle Scholar
  7. 7.
    Cofield RH, Edgerton BC (1989) Total shoulder arthroplasty: complications and revision surgery. Instr Course Lect 39:449–462Google Scholar
  8. 8.
    Cuff D (2008) Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 90(6):1244–1251CrossRefPubMedGoogle Scholar
  9. 9.
    Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM (2010) Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 19:1115–1120CrossRefPubMedGoogle Scholar
  10. 10.
    Denard PJ, Walch G (2013) Current concepts in the surgical management of primary glenohumeral arthritis with a biconcave glenoid. J Shoulder Elbow Surg 22:1589–1598CrossRefPubMedGoogle Scholar
  11. 11.
    Deshmukh AV, Koris M, Zurakowski D, Thornhill TS (2005) Total shoulder arthroplasty: long-term survivorship, functional outcome, and quality of life. J Shoulder Elbow Surg 14:471–479CrossRefPubMedGoogle Scholar
  12. 12.
    Ek ET, Neukom L, Catanzaro S, Gerber C (2013) Reverse total shoulder arthroplasty for massive irreparable rotator cuff tears in patients younger than 65 years old: results after five to fifteen years. J Shoulder Elbow Surg 22:1199–1208CrossRefPubMedGoogle Scholar
  13. 13.
    Fox TJ, Cil A, Sperling JW, Sanchez-Sotelo J, Schleck CD, Cofield RH (2009) Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elbow Surg 18:859–863CrossRefPubMedGoogle Scholar
  14. 14.
    Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M (2005) The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. J Bone Joint Surg Am 87:1697–1705PubMedGoogle Scholar
  15. 15.
    Franta AK, Lenters TR, Mounce D, Neradilek B, Matsen FA (2007) The complex characteristics of 282 unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg 16:555–562CrossRefPubMedGoogle Scholar
  16. 16.
    Friedman RJ, Hawthorne KB, Genez BM (1992) The use of computerized tomography in the measurement of glenoid version. J Bone Joint Surg 74:1032–1037CrossRefPubMedGoogle Scholar
  17. 17.
    Friedman RJ, Hawthorne KB, Genez BM (1992) Glenoid augmentation for total shoulder arthroplasty. Orthop Trans 16:66Google Scholar
  18. 18.
    Gerber C, Costouros JG, Sukthankar A, Fucentese SF (2009) Static posterior humeral head subluxation and total shoulder arthroplasty. J Shoulder Elbow Surg 18:505–510CrossRefPubMedGoogle Scholar
  19. 19.
    Gillespie R, Lyons R, Lazarus M (2009) Eccentric reaming in total shoulder arthroplasty: a cadaveric study. Orthopedics 32:21CrossRefPubMedGoogle Scholar
  20. 20.
    Godenèche A, Boileau P, Favard L, Le Huec J‑C, Lévigne C, Nové-Josserand L, Walch G, Edwards TB (2002) Prosthetic replacement in the treatment of osteoarthritis of the shoulder: early results of 268 cases. J Shoulder Elbow Surg 11:11–18CrossRefPubMedGoogle Scholar
  21. 21.
    Guery J, Favard L, Sirveaux F, Oudet D, Mole D, Walch G (2006) Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 88:1742–1747PubMedGoogle Scholar
  22. 22.
    Habermeyer P, Magosch P, Lichtenberg S (2007) Recentering the humeral head for glenoid deficiency in total shoulder arthroplasty. Clin Orthop Relat Res 457:124–132PubMedGoogle Scholar
  23. 23.
    Hatzidakis AM, Norris TR, Boileau P (2005) Reverse shoulder arthroplasty indications, technique, and results. Tech Shoulder Elbow Surg 6:135–149CrossRefGoogle Scholar
  24. 24.
    Hill JM, Norris TR (2001) Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid. J Bone Joint Surg Am 83(6):877–883CrossRefPubMedGoogle Scholar
  25. 25.
    Ho JC, Sabesan VJ, Iannotti JP (2013) Glenoid component retroversion is associated with osteolysis. J Bone Joint Surg Am 95:e82CrossRefPubMedGoogle Scholar
  26. 26.
    Iannotti JP, Frangiamore SJ (2012) Fate of large structural allograft for treatment of severe uncontained glenoid bone deficiency. J Shoulder Elbow Surg 21:765–771CrossRefPubMedGoogle Scholar
  27. 27.
    Iannotti JP, Norris TR (2003) Influence of preoperative factors on outcome of shoulder arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am 85:251–258CrossRefPubMedGoogle Scholar
  28. 28.
    Iannotti JP, Greeson C, Downing D, Sabesan V, Bryan JA (2012) Effect of glenoid deformity on glenoid component placement in primary shoulder arthroplasty. J Shoulder Elbow Surg 21:48–55CrossRefPubMedGoogle Scholar
  29. 29.
    Iannotti JP, Lappin KE, Klotz CL, Reber EW, Swope SW (2013) Liftoff resistance of augmented glenoid components during cyclic fatigue loading in the posterior-superior direction. J Shoulder Elbow Surg 22:1530–1536CrossRefPubMedGoogle Scholar
  30. 30.
    Jarrett CD, Brown BT, Schmidt CC (2013) Reverse shoulder arthroplasty. Orthop Clin North Am 44:389–408CrossRefPubMedGoogle Scholar
  31. 31.
    Kirane YM, Lewis GS, Sharkey NA, Armstrong AD (2012) Mechanical characteristics of a novel posterior-step prosthesis for biconcave glenoid defects. J Shoulder Elbow Surg 21:105–115CrossRefPubMedGoogle Scholar
  32. 32.
    Klika BJ, Wooten CW, Sperling JW, Steinmann S, Schleck CD, Harmsen WS, Cofield RH (2014) Structural bone grafting for glenoid deficiency in primary total shoulder arthroplasty. J Shoulder Elbow Surg 23:1066–1072CrossRefPubMedGoogle Scholar
  33. 33.
    Lederman ES, Harmsen S, Hatzidakis AM, Kelly JD, Edwards TB (2014) Reverse total shoulder arthroplasty is associated with good clinical outcomes that are sustained through mid-term follow-up: a prospective cohort study. J Shoulder Elbow Surg 9:e229CrossRefGoogle Scholar
  34. 34.
    Lévigne C, Boileau P, Favard L, Garaud P, Mole D, Sirveaux F, Walch G (2008) Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg 17:925–935CrossRefPubMedGoogle Scholar
  35. 35.
    Levine WN, Djurasovic M, Glasson J‑M, Pollock RG, Flatow EL, Bigliani LU (1997) Hemiarthroplasty for glenohumeral osteoarthritis: results correlated to degree of glenoid wear. J Shoulder Elbow Surg 6:449–454CrossRefPubMedGoogle Scholar
  36. 36.
    Matsen FA (1994) Practical evaluation and management of the shoulder. Saunders, PhiladelphiaGoogle Scholar
  37. 37.
    Matsen FA III, Gupta A (2014) Axillary view: arthritic glenohumeral anatomy and changes after ream and run. Clin Orthop Relat Res 472:894–902CrossRefPubMedGoogle Scholar
  38. 38.
    Matsen FA, Clinton J, Lynch J, Bertelsen A, Richardson ML (2008) Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am 90:885–896CrossRefPubMedGoogle Scholar
  39. 39.
    Matsen FA III, Warme WJ, Jackins SE (2015) Can the ream and run procedure improve glenohumeral relationships and function for shoulders with the arthritic triad? Clin Orthop Relat Res 473:2088–2096CrossRefPubMedGoogle Scholar
  40. 40.
    Mizuno N, Denard PJ, Raiss P, Walch G (2013) Reverse total shoulder arthroplasty for primary glenohumeral osteoarthritis in patients with a biconcave glenoid. J Bone Joint Surg Am 95:1297CrossRefPubMedGoogle Scholar
  41. 41.
    Moeller AD, Thorsen RR, Torabi TP, Bjoerkman A‑SD, Christensen EH, Maribo T, Christiansen DH (2014) The Danish version of the modified constant-Murley shoulder score: reliability, agreement, and construct validity. J Orthop Sports Phys Ther 44:336–A5CrossRefPubMedGoogle Scholar
  42. 42.
    Mulieri P, Dunning P, Klein S, Pupello D, Frankle M (2010) Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Am 92:2544–2556CrossRefPubMedGoogle Scholar
  43. 43.
    Neer CS (1974) Replacement arthroplasty for glenohumeral osteoarthritis. J Bone Jt Surg 56:1–13CrossRefGoogle Scholar
  44. 44.
    Neer CS, Morrison DS (1988) Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg 70:1154–1162CrossRefPubMedGoogle Scholar
  45. 45.
    Neer C, Watson KC, Stanton FJ (1982) Recent experience in total shoulder replacement. J Bone Joint Surg 64:319–337CrossRefPubMedGoogle Scholar
  46. 46.
    Neyton L, Boileau P, Nové-Josserand L, Edwards TB, Walch G (2007) Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg 16:S71–S78CrossRefPubMedGoogle Scholar
  47. 47.
    Nolan BM, Ankerson E, Wiater JM (2011) Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res 469:2476–2482CrossRefPubMedGoogle Scholar
  48. 48.
    Norris TR, Iannotti JP (2002) Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg 11:130–135CrossRefPubMedGoogle Scholar
  49. 49.
    Norris TR, Kelly JD, Humphrey CS (2007) Management of glenoid bone defects in revision shoulder arthroplasty: a new application of the reverse total shoulder prosthesis. Tech Shoulder Elbow Surg 8:37–46CrossRefGoogle Scholar
  50. 50.
    Nowak DD, Bahu MJ, Gardner TR, Dyrszka MD, Levine WN, Bigliani LU, Ahmad CS (2009) Simulation of surgical glenoid resurfacing using three-dimensional computed tomography of the arthritic glenohumeral joint: the amount of glenoid retroversion that can be corrected. J Shoulder Elbow Surg 18:680–688CrossRefPubMedGoogle Scholar
  51. 51.
    Rice RS, Sperling JW, Miletti J, Schleck C, Cofield RH (2008) Augmented glenoid component for bone deficiency in shoulder arthroplasty. Clin Orthop Relat Res 466:579–583CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Richards RR, An K‑N, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352CrossRefPubMedGoogle Scholar
  53. 53.
    Sabesan V, Callanan M, Ho J, Iannotti JP (2013) Clinical and radiographic outcomes of total shoulder arthroplasty with bone graft for osteoarthritis with severe glenoid bone loss. J Bone Joint Surg Am 95:1290–1296CrossRefPubMedGoogle Scholar
  54. 54.
    Sabesan V, Callanan M, Sharma V, Iannotti JP (2014) Correction of acquired glenoid bone loss in osteoarthritis with a standard versus an augmented glenoid component. J Shoulder Elbow Surg 23:964–973CrossRefPubMedGoogle Scholar
  55. 55.
    Scalise JJ, Iannotti JP (2008) Bone grafting severe glenoid defects in revision shoulder arthroplasty. Clin Orthop Relat Res 466:139–145CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Sears BW, Johnston PS, Ramsey ML, Williams GR (2012) Glenoid bone loss in primary total shoulder arthroplasty: evaluation and management. J Am Acad Orthop Surg 20:604–613PubMedGoogle Scholar
  57. 57.
    Singh JA, Sperling JW, Cofield RH (2011) Revision surgery following total shoulder arthroplasty analysis of 2588 shoulders over three decades (1976 to 2008). J Bone Jt Surg Br 93:1513–1517CrossRefGoogle Scholar
  58. 58.
    Smithers CJ, Young AA, Walch G (2011) Reverse shoulder arthroplasty. Curr Rev Musculoskelet Med 4:183–190CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Steinmann SP, Cofield RH (2000) Bone grafting for glenoid deficiency in total shoulder replacement. J Shoulder Elbow Surg 9:361–367CrossRefPubMedGoogle Scholar
  60. 60.
    Stephens SP, Paisley KC, Jeng J, Dutta AK, Wirth MA (2015) Shoulder arthroplasty in the presence of posterior glenoid bone loss. J Bone Joint Surg Am 97:251–259CrossRefPubMedGoogle Scholar
  61. 61.
    Walch G et al (2012) Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid. J Shoulder Elbow Surg 21:1526–1533CrossRefPubMedGoogle Scholar
  62. 62.
    Walch G, Badet R, Boulahia A, Khoury A (1999) Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty 14:756–760CrossRefPubMedGoogle Scholar
  63. 63.
    Walch G, Young AA, Boileau P, Loew M, Gazielly D, Mole D (2012) Patterns of loosening of polyethylene keeled glenoid components after shoulder arthroplasty for primary osteoarthritis. J Bone Joint Surg Am 94(2):145–150CrossRefPubMedGoogle Scholar
  64. 64.
    Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89:1476–1485PubMedGoogle Scholar
  65. 65.
    Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC (1999) Comparison of the single assessment numeric evaluation method and two shoulder rating scales outcomes measures after shoulder surgery. Am J Sports Med 27:214–221CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH 2017

Authors and Affiliations

  1. 1.The Orthopedic Clinic AssociationPhoenixUSA
  2. 2.The San Francisco Shoulder, Elbow, and Hand ClinicSan FranciscoUSA

Personalised recommendations