title: Management of humeral and glenoid bone loss--associated with glenohumeral instability.
abstract: Anterior glenohumeral instability complicated by bone loss is a challenging problem and, when severe, may require surgical treatment with bone grafting. We review our institution's experience with humeral head and glenoid bone grafting for large Hill-Sachs lesions and glenoid defects.
  
  
  METHODS
  Patients who underwent intra-articular bone reconstruction for Hill-Sachs and large glenoid defects for anterior instability at our institution during 2002-2008 were retrospectively reviewed. Those who had undergone concomitant humeral head replacement were excluded. Six patients were identified as having undergone allograft or autograft iliac crest bone graft reconstruction of the glenoid, with four available for full follow-up (average 39 months; range, 7 to 63). Five patients were identified as having undergone humeral head allograft reconstruction and four were available for full follow-up (average 28 months; range, 11 to 40). The remaining three patients were available for telephone follow-up. American Shoulder and Elbow Society (ASES) and University of California, Los Angles (UCLA) scores were recorded and radiographs obtained.
  
  
  RESULTS
  Average postoperative ASES and UCLA scores for glenoid bone graft patients were 91 and 33, respectively. Average postoperative ASES and UCLA scores for humeral bone graft patients were 85.3 and 28.4, respectively. Glenoid bone graft shoulders, when compared to the opposite normal side, lost an average of 3° of forward flexion, 10° of external rotation, and two levels of internal rotation. Humeral head bone-grafted shoulders, lost an average of 23° of forward flexion, 8° of external rotation, and two levels of internal rotation. No episodes of recurrent subluxation or dislocations were reported. Radiographs showed no evidence of graft resorption or hardware prominence.
  
  
  CONCLUSIONS
  Bone grafting procedures around the shoulder for the treatment of instability provided relief from recurrent instability and good functional results.
authors.affiliation: Department of Orthopedics, Wright State University, Dayton VA Medical Center, 4100 W. 3rd Street, Dayton, OH 45428, USA. mjd_68@yahoo.com
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: DiPaola
authors.forename: Laith M
authors.initials: LM
authors.lastname: Jazrawi
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Rokito
authors.forename: Young W
authors.initials: YW
authors.lastname: Kwon
authors.forename: Lava
authors.initials: L
authors.lastname: Patel
authors.forename: Brian
authors.initials: B
authors.lastname: Pahk
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Zuckerman
mesh_terms: D000328:Adult; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D016723:Bone Remodeling; D016025:Bone Transplantation; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000601:surgery*; D007085:Ilium / Q000637:transplantation*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult