title: Structural bone grafting for glenoid deficiency in primary total shoulder arthroplasty.
abstract: BACKGROUND
  Glenoid bone grafting can be useful to restore an asymmetrically eroded glenoid to better support the glenoid component and improve positioning. The purpose of this study was to evaluate the clinical and radiographic results of patients undergoing structural bone grafting for glenoid deficiency with placement of a cemented glenoid component during primary total shoulder arthroplasty.
  
  
  METHODS
  Between January 1, 1976, and December 31, 2008, 24 patients (25 shoulders) of 2607 shoulders undergoing primary total shoulder arthroplasty (0.96%) had structural bone grafting with a humeral head autograft and screw fixation. The mean clinical follow-up was 8.7 years, and the mean radiographic follow-up was 7.6 years.
  
  
  RESULTS
  Twenty-three shoulders experienced pain relief, and patients expressed satisfaction with the operation in these shoulders. Postoperative active elevation averaged 148°, and external rotation with the arm at the side averaged 60°. On radiographic evaluation, 10 shoulders had glenoids at risk for component loosening. Two of these shoulders were symptomatic and underwent revision surgery to address glenoid component loosening. The Neer result rating was excellent in 18 shoulders, satisfactory in 5, and unsatisfactory in the 2 shoulders undergoing revision.
  
  
  CONCLUSIONS
  Structural bone grafting in primary total shoulder arthroplasty is uncommonly necessary. When it is performed, the clinical outcomes are favorable; however, radiographic analysis shows a moderate rate of failure of glenoid component fixation. It seems likely that alternative treatment methods may prove to be more effective in addressing glenoid wear.
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Brian J
authors: BJ
authors: Klika
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Clint W
authors: CW
authors: Wooten
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: John W
authors: JW
authors: Sperling
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Scott P
authors: SP
authors: Steinmann
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Cathy D
authors: CD
authors: Schleck
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: William S
authors: WS
authors: Harmsen
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: cofield.robert@mayo.edu.
authors: Robert H
authors: RH
authors: Cofield
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000601:surgery*; D019643:Arthroplasty, Replacement; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058430:Humeral Head / Q000637:transplantation; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012540:Scapula / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: Glenoid deficiency; bone graft; total shoulder arthroplasty