Abstract
Background
The indications for reverse shoulder arthroplasty have grown dramatically during the past decade. In a relevant proportion of cases, there are accompanying significant glenoid bony defects.
Objectives
We aimed to review and summarize the current literature on the management of glenoid defects in reverse shoulder arthroplasties and to describe our approach.
Results
Currently, there are no treatment algorithms based on a specific classification system of glenoid defects in reverse shoulder arthroplasty published in the peer-reviewed literature. The authors distinguish between defects that are centric (contained), eccentric (uncontained). The literature mostly describes biological reconstruction of the defect by an autograft, with only a few allograft cases reported. Furthermore, it is unclear whether the procedure can be performed in a one- (glenoid defect reconstruction and implantation of reverse shoulder) or two-stage approach. We prefer a one-stage procedure if there is sufficient fixation of the central peg of the metaglene and good locking screw fixation in the native scapula. In advanced defects, specific glenoid base plates with a longer peg are necessary. In the literature and in our experience, the complication rate for this indication is not higher than with reverse arthroplasties without glenoid defects. Metal-augmented glenoid base plates are a possible alternative to biological reconstruction.
Conclusion
Glenoid defects concomitant with reverse shoulder arthroplasties represent a significant percentage of surgically difficult-to-treat patients. It is critical to distinguish between the different types of glenoid defects and to adjust the surgical procedure to the individual defect. In the majority of cases, a one-stage procedure is possible by using specific glenoid base plate designs.
Zusammenfassung
Hintergrund
In den letzten 10 Jahren hat die Zahl der Indikationen zur inversen Schulterendoprothesenversorgung deutlich zugenommen. In einem bedeutenden Teil der Fälle bestehen wesentliche begleitende Knochendefekte des Glenoids.
Ziel der Arbeit
Ziel war ein zusammenfassender Überblick über die aktuelle Literatur zur Behandlung von Glenoiddefekten bei der inversen Schulterendoprothesenversorgung und die Beschreibung des eigenen Ansatzes.
Ergebnisse
Derzeit gibt es in der Literatur keine Therapiealgorithmen auf der Grundlage eines spezifischen Klassifikationssystems von Glenoiddefekten bei inverser Schulterendoprothesenversorgung. Die Autoren unterscheiden zwischen zentrischen (eingefassten) und exzentrischen (nicht eingefassten) Defekten. In der Literatur wird meist die biologische Rekonstruktion des Defekts mittels Autograft beschrieben, nur einige wenige Fälle mit einem Allograft sind dokumentiert. Darüber hinaus ist es unklar, ob das Verfahren einzeitig (Glenoiddefektrekonstruktion und Implantation der inversen Schulterendoprothese) oder zweizeitig durchgeführt werden kann. Die Autoren bevorzugen ein einzeitiges Vorgehen, wenn eine ausreichende Fixation des zentralen Metaglene-Zapfens und gute Fixation mit winkelstabilen Schrauben in der nativen Skapula möglich ist. Bei fortgeschrittenen Defekten sind spezielle Glenoidbasisplatten mit einem längeren Zapfen notwendig. In der Literatur und nach Erfahrung der Autoren ist die Komplikationsrate für diese Indikation nicht höher als bei inverser Prothesenversorgung ohne Glenoiddefekt. Metallverstärkte Glenoidgrundplatten sind eine mögliche Alternative zur biologischen Rekonstruktion.
Schlussfolgerung
Patienten mit Glenoiddefekt und gleichzeitiger inverser Schulterprothesenversorgung stellen einen signifikanten Anteil der schwierig zu behandelnden chirurgischen Patienten dar. Es ist entscheidend, zwischen den verschiedenen Typen von Glenoiddefekten zu unterscheiden und das chirurgische Vorgehen auf den jeweiligen Defekt gezielt auszurichten. In der Mehrheit der Fälle ist ein einseitiges Vorgehen mit Verwendung eines speziellen Designs der Glenoidgrundplatte möglich.
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L. Seebauer and A.L. Ekelund are consultants and receive royalties from DePuy-Synthes.
This article does not contain any studies with human participants or animals performed by any of the authors.
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Seebauer, L., Ekelund, A.L. Management of glenoid bone loss in primary and revision reverse total shoulder arthroplasty. Obere Extremität 12, 6–15 (2017). https://doi.org/10.1007/s11678-017-0396-2
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DOI: https://doi.org/10.1007/s11678-017-0396-2
Keywords
- Arthroplasty
- Shoulder
- Glenoid defect
- Reconstructive surgery
- Grafting, bone
- Reverse total shoulder arthroplasty