Adding a Bone Graft to Reverse TSA
The reverse total shoulder arthroplasty has been well established as a successful treatment for rotator cuff arthropathy (RCA). The native glenoid is infrequently normal in the setting of a massive rotator cuff tear, and bone loss has been reported to be as high as 40% in some studies (Frankle et al., J Shoulder Elb Surg 18:874–85, 2009; Klein et al., J Bone Joint Surg Am 92:1144–54, 2010). With superior migration of the humeral head, there tends to be a vertical wear pattern that differentiates this pathology from primary osteoarthritis. Failure to recognize this wear pattern can lead to an error in surgical technique and may result in inadequate glenoid fixation or superior tilt of the glenosphere. These errors can lead to poor patient outcomes and early failure of the implant.
At times, the glenoid bone loss can be managed with careful preferential reaming of the inferior glenoid. Other patients with more significant bone loss benefit from grafting the glenoid, thereby maximizing surface contact and minimizing risk of superior tilt. The following case highlights the steps taken to treat a patient with superior bone loss in the setting of rotator cuff arthropathy.
KeywordsReverse shoulder arthroplasty Rotator cuff tear Glenoid bone loss
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