Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty.
BACKGROUND
Revision of a shoulder arthroplasty to a reverse shoulder arthroplasty in the presence of glenoid bone loss is especially challenging. The purpose of the present study was to determine the complications and results of glenoid bone-grafting in revision to a reverse shoulder arthroplasty.


METHODS
Between 2005 and 2010, 143 consecutive reverse shoulder arthroplasties performed as revision procedures were performed at our institution. Glenoid bone-grafting was performed in forty-one shoulders (29%), with 98% (forty) that had follow-up of more than two years (mean, 3.1 years). The 102 patients who did not undergo grafting served as a control group.


RESULTS
Seven patients (18%) required another revision surgery because of glenoid loosening (four patients), instability (two patients), or infection (one patient). The two and five-year implant survival rate free of revision for shoulders that had glenoid bone-grafting was 88% and 76%, respectively, which was lower than that for patients who had not required glenoid bone-grafting. The survival rate free of radiographic glenoid loosening at two and five years for the shoulders that had bone-grafting was 92% and 89%, respectively, which was worse than that for those that had not had glenoid bone-grafting. Patients had significant pain relief and improvement in their shoulder range of motion, and they had an increased level of satisfaction compared with the preoperative status. Increased rates of glenoid loosening were seen in patients who had an increased body mass index, an implant with a lateral center of rotation, a previous total shoulder replacement (versus hemiarthroplasty), and in those who were smokers.


CONCLUSIONS
Although there were relatively high rates of glenoid loosening and reoperation at mid-term follow-up, glenoid reconstruction with bone graft in the revision setting was able to relieve pain and restore shoulder function and stability.
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for E. Wagner: wagner.eric@mayo.edu. E-mail address for M.T. Houdek: houdek.matthew@mayo.edu. E-mail address for T. Griffith: griffith.timothy@mayo.edu. E-mail address for B.T. Elhassan: elhassan.bassem@mayo.edu. E-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu. E-mail address for J.W. Sperling: sperling.john@mayo.edu. E-mail address for R.H. Cofield: cofield.robert@mayo.edu.
Eric
E
Wagner
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for E. Wagner: wagner.eric@mayo.edu. E-mail address for M.T. Houdek: houdek.matthew@mayo.edu. E-mail address for T. Griffith: griffith.timothy@mayo.edu. E-mail address for B.T. Elhassan: elhassan.bassem@mayo.edu. E-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu. E-mail address for J.W. Sperling: sperling.john@mayo.edu. E-mail address for R.H. Cofield: cofield.robert@mayo.edu.
Matthew T
MT
Houdek
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for E. Wagner: wagner.eric@mayo.edu. E-mail address for M.T. Houdek: houdek.matthew@mayo.edu. E-mail address for T. Griffith: griffith.timothy@mayo.edu. E-mail address for B.T. Elhassan: elhassan.bassem@mayo.edu. E-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu. E-mail address for J.W. Sperling: sperling.john@mayo.edu. E-mail address for R.H. Cofield: cofield.robert@mayo.edu.
Timothy
T
Griffith
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for E. Wagner: wagner.eric@mayo.edu. E-mail address for M.T. Houdek: houdek.matthew@mayo.edu. E-mail address for T. Griffith: griffith.timothy@mayo.edu. E-mail address for B.T. Elhassan: elhassan.bassem@mayo.edu. E-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu. E-mail address for J.W. Sperling: sperling.john@mayo.edu. E-mail address for R.H. Cofield: cofield.robert@mayo.edu.
Bassem T
BT
Elhassan
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for E. Wagner: wagner.eric@mayo.edu. E-mail address for M.T. Houdek: houdek.matthew@mayo.edu. E-mail address for T. Griffith: griffith.timothy@mayo.edu. E-mail address for B.T. Elhassan: elhassan.bassem@mayo.edu. E-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu. E-mail address for J.W. Sperling: sperling.john@mayo.edu. E-mail address for R.H. Cofield: cofield.robert@mayo.edu.
Joaquin
J
Sanchez-Sotelo
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for E. Wagner: wagner.eric@mayo.edu. E-mail address for M.T. Houdek: houdek.matthew@mayo.edu. E-mail address for T. Griffith: griffith.timothy@mayo.edu. E-mail address for B.T. Elhassan: elhassan.bassem@mayo.edu. E-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu. E-mail address for J.W. Sperling: sperling.john@mayo.edu. E-mail address for R.H. Cofield: cofield.robert@mayo.edu.
John W
JW
Sperling
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for E. Wagner: wagner.eric@mayo.edu. E-mail address for M.T. Houdek: houdek.matthew@mayo.edu. E-mail address for T. Griffith: griffith.timothy@mayo.edu. E-mail address for B.T. Elhassan: elhassan.bassem@mayo.edu. E-mail address for J. Sanchez-Sotelo: sanchez.joaquin@mayo.edu. E-mail address for J.W. Sperling: sperling.john@mayo.edu. E-mail address for R.H. Cofield: cofield.robert@mayo.edu.
Robert H
RH
Cofield
D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D016025:Bone Transplantation; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012540:Scapula / Q000000981:diagnostic imaging / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome