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Adding a Bone Graft to Reverse TSA

  • Jesse W. Allert
  • Mark A. FrankleEmail author
Chapter

Abstract

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.

Keywords

Reverse shoulder arthroplasty Rotator cuff tear Glenoid bone loss 

References

  1. 1.
    Frankle MA, Teramoto A, Luo ZP, Levy JC, Pupello D. Glenoid morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elb Surg. 2009;18(6):874–85. doi: 10.1016/j.jse.2009.02.013.CrossRefGoogle Scholar
  2. 2.
    Klein SM, Dunning P, Mulieri P, Pupello D, Downes K, Frankle MA. Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse shoulder arthroplasty. J Bone Joint Surg Am. 2010;92(5):1144–54. doi: 10.2106/JBJS.I.00778.CrossRefPubMedGoogle Scholar
  3. 3.
    Boileau P, et al. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg. 2005;14(1 Suppl S):147S–61S.CrossRefPubMedGoogle Scholar
  4. 4.
    Klein S, Levy JC, Holcomb JO, Pupello D, Frankle MA. Treatment of advanced rotator cuff dysfunction with reverse shoulder arthroplasty. Minerva Ortop Traumatol. 2009;60(1):29–46.Google Scholar
  5. 5.
    Gagey O, Hue E. Mechanics of the deltoid muscle. A new approach. Clin Orthop Relat Res. 2000;375:250–7.CrossRefGoogle Scholar
  6. 6.
    Norris T, Kelly JD, Humphrey CS. Management of glenoid bone defects in revision shoulder arthroplasty: a new application of the reverse total shoulder prosthesis. Tech Shoulder Elb Surg. 2007;8(1):37–46.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Shoulder and Elbow ServiceFlorida Orthopaedic InstituteTampaUSA

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