Skip to main content
SpringerLink
Log in

Bone Grafting Severe Glenoid Defects in Revision Shoulder Arthroplasty

  • Original Article
  • Shoulder
  • Published:
Clinical Orthopaedics and Related Research

Abstract

During revision total shoulder arthroplasty, bone grafting severe glenoid defects without concomitant reinsertion of a glenoid prosthesis may be the only viable reconstructive option. However, the fate of these grafts is unknown. We questioned the durability and subsidence of the graft and the associated clinical outcomes in patients who have this procedure. We retrospectively reviewed 11 patients with severe glenoid deficiencies from aseptic loosening of a glenoid component who underwent conversion of a total shoulder arthroplasty to a humeral head replacement and glenoid bone grafting. Large cavitary defects were grafted with either allograft cancellous chips or bulk structural allograft, depending on the presence or absence of glenoid vault wall defects, without prosthetic glenoid resurfacing. Clinical outcomes (Penn Shoulder Score, maximum 100 points) improved from 23 to 57 at a minimum 2-year followup (mean, 38 months; range, 24–73 months). However, we observed substantial graft subsidence in all patients, with eight of 11 patients having subsidence greater than 5 mm; the magnitude of graft resorption did not correlate with clinical outcome scores. Greater subsidence was seen with structural than cancellous chip allografts. Bone grafting large glenoid defects during revision shoulder arthroplasty can improve clinical outcome scores, but the substantial resorption of the graft material remains a concern.

Level of Evidence: Level III Prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2
Fig. 3A–C

Similar content being viewed by others

References

  1. Antuna SA, Sperling JW, Cofield RH, Rowland CM. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001;10:217–224.

    Article  PubMed  CAS  Google Scholar 

  2. Cheung EV, Sperling JW, Cofield RH. Reimplantation of a glenoid component following component removal and allogenic bone-grafting. J Bone Joint Surg Am. 2007;89:1777–1783.

    Article  PubMed  Google Scholar 

  3. Constant CR. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br. 1997;79:695–696.

    PubMed  CAS  Google Scholar 

  4. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.

    PubMed  Google Scholar 

  5. Cook KF, Gartsman GM, Roddey TS, Olson SL. The measurement level and trait-specific reliability of 4 scales of shoulder functioning: an empiric investigation. Arch Phys Med Rehabil. 2001;82:1558–1565.

    Article  PubMed  CAS  Google Scholar 

  6. Engh GA, Herzwurm PJ, Parks NL. Treatment of major defects of bone with bulk allografts and stemmed components during total knee arthroplasty. J Bone Joint Surg Am. 1997;79:1030–1039.

    PubMed  CAS  Google Scholar 

  7. Farron A, Terrier A, Buchler P. Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg. 2006;15:521–526.

    Article  PubMed  Google Scholar 

  8. Gartsman GM, Roddey TS, Hammerman SM. Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis. J Bone Joint Surg Am. 2000;82:26–34.

    PubMed  CAS  Google Scholar 

  9. Hawkins RJ, Greis PE, Bonutti PM. Treatment of symptomatic glenoid loosening following unconstrained shoulder arthroplasty. Orthopedics. 1999;22:229–234.

    PubMed  CAS  Google Scholar 

  10. Hill JM, Norris TR. Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid. J Bone Joint Surg Am. 2001;83:877–883.

    Article  PubMed  Google Scholar 

  11. Iannotti JP, Williams GR Jr. Disorders of the Shoulder: Diagnosis and Management. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.

    Google Scholar 

  12. Leggin BG, Michener LA, Shaffer MA, Brenneman SK, Iannotti JP, Williams GR Jr. The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther. 2006;36:138–151.

    PubMed  Google Scholar 

  13. Martin SD, Zurakowski D, Thornhill TS. Uncemented glenoid component in total shoulder arthroplasty: survivorship and outcomes. J Bone Joint Surg Am. 2005;87:1284–1292.

    Article  PubMed  Google Scholar 

  14. Michener LA, Leggin BG. A review of self-report scales for the assessment of functional limitation and disability of the shoulder. J Hand Ther. 2001;14:68–76.

    PubMed  CAS  Google Scholar 

  15. Neer CS 2nd, Morrison DS. Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg Am. 1988;70:1154–1162.

    PubMed  Google Scholar 

  16. Neer CS 2nd, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg Am. 1982;64:319–337.

    PubMed  Google Scholar 

  17. Neyton L, Walch G, Nove-Josserand L, Edwards TB. Glenoid corticocancellous bone grafting after glenoid component removal in the treatment of glenoid loosening. J Shoulder Elbow Surg. 2006;15:173–179.

    Article  PubMed  Google Scholar 

  18. Phipatanakul WP, Norris TR. Treatment of glenoid loosening and bone loss due to osteolysis with glenoid bone grafting. J Shoulder Elbow Surg. 2006;15:84–87.

    Article  PubMed  Google Scholar 

  19. Rodosky MW, Weinstein DM, Pollock RG. On the rarity of glenoid component failure. J Shoulder Elbow Surg. 1995;4:3–4.

    Article  Google Scholar 

  20. Shinar AA, Harris WH. Bulk structural autogenous grafts and allografts for reconstruction of the acetabulum in total hip arthroplasty: sixteen-year-average follow-up. J Bone Joint Surg Am. 1997;79:159–168.

    PubMed  CAS  Google Scholar 

  21. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am. 2007;89:588–600.

    Article  PubMed  Google Scholar 

  22. Sperling JW, Cofield RH, Rowland CM. Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less: long-term results. J Bone Joint Surg Am. 1998;80:464–473.

    PubMed  CAS  Google Scholar 

  23. Sporer SM, O’Rourke M, Chong P, Paprosky WG. The use of structural distal femoral allografts for acetabular reconstruction: average ten-year follow-up. J Bone Joint Surg Am. 2005;87:760–765.

    Article  PubMed  Google Scholar 

  24. Vyskocil P, Gerber C, Bamert P. Radiolucent lines and component stability in knee arthroplasty: standard versus fluoroscopically-assisted radiographs. J Bone Joint Surg Br. 1999;81:24–26.

    Article  PubMed  CAS  Google Scholar 

  25. Wirth MA, Rockwood CA Jr. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am. 1996;78:603–616.

    PubMed  CAS  Google Scholar 

  26. Zmolek JC, Dorr LD. Revision total hip arthroplasty: the use of solid allograft. J Arthroplasty. 1993;8:361–370.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The CORE Institute, 14420 W Meeker Blvd, Suite 300, Sun City West, AZ, 85375, USA

    Jason J. Scalise MD

  2. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Joseph P. Iannotti MD, PhD

Authors
  1. Jason J. Scalise MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph P. Iannotti MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason J. Scalise MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was not required by our Institutional Review Board after review and approval of the protocol.

About this article

Cite this article

Scalise, J.J., Iannotti, J.P. Bone Grafting Severe Glenoid Defects in Revision Shoulder Arthroplasty. Clin Orthop Relat Res 466, 139–145 (2008). https://doi.org/10.1007/s11999-007-0065-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-007-0065-7

Keywords

Search

Navigation