"Shaped" humeral head autograft reverse shoulder arthroplasty : Treatment for primary glenohumeral osteoarthritis with significant posterior glenoid bone loss (B2, B3, and C type).

ABSTRACT

BACKGROUND: 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. OBJECTIVES: 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 (n = 16), B3 (n = 10), or C (n = 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. RESULTS: 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. CONCLUSIONS: "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.