title: Primary shoulder arthroplasty using a custom-made hip-inspired implant for the treatment of advanced glenohumeral arthritis in the presence of severe glenoid bone loss.
abstract: BACKGROUND
  Total shoulder arthroplasty for end-stage glenohumeral arthritis with severe glenoid bone loss poses a unique challenge for shoulder surgeons. Current surgical solutions are limited and associated with high complication rates. We hypothesized that a custom-made computer-aided design-computer-aided manufacturing (CAD-CAM) total shoulder replacement (TSR; Stanmore Implants Worldwide, Elstree, UK) resembling a total hip prosthesis could offer a reliable alternative for this challenging subset of patients.
  
  
  METHODS
  Thirty-seven patients with rotator cuff-deficient end-stage glenohumeral arthritis and severe glenoid bone loss (assessed as not amenable to treatment with standard anatomic or reverse total shoulder implants) were treated with the CAD-CAM TSR between 2006 and 2013. Clinical data were collected prospectively and analyzed at a mean follow-up of 5 years.
  
  
  RESULTS
  Postoperatively, the pain level with activity decreased from 9.2 ± 1.7 to 2.4 ± 2.9 (P < .001). The Oxford Shoulder Score improved from 11 ± 8 points to 27 ± 11 points (P < .001), and the Subjective Shoulder Value (on a 0%-100% scale) improved from 23% ± 14% to 60% ± 24% (P < .001). Active forward elevation improved from 39° ± 23° to 63° ± 38° (P < .001), and external rotation improved from 6° ± 16° to 15° ± 17° (P = .001). Component revision was required in 6 of 37 patients (16%) (glenoid loosening in 1, humeral stem loosening in 3, periprosthetic fracture in 1, and prosthesis dislocation in 1).
  
  
  CONCLUSIONS
  The CAD-CAM TSR offers a reliable alternative for the treatment of end-stage glenohumeral arthritis with severe glenoid deficiency not amenable to standard anatomic or reverse total shoulder implants, with maintenance of significant pain relief and clinical-functional improvement at 5-year postoperative follow-up.
authors: Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors: Ramsey
authors: R
authors: Chammaa
authors: Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. Electronic address: ofiruri@gmail.com.
authors: Ofir
authors: O
authors: Uri
authors: Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
authors: Simon
authors: S
authors: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D017076:Computer-Aided Design; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000072227:Shoulder Prosthesis; D016896:Treatment Outcome; D055815:Young Adult
keywords: CAD-CAM shoulder; Total shoulder arthroplasty; custom shoulder implant; glenoid bone loss; glenoid deficiency; hip-inspired shoulder replacement; rotator cuff arthropathy