Reverse Total Shoulder Arthroplasty without Bone-Grafting for Severe Glenoid Bone Loss in Patients with Osteoarthritis and Intact Rotator Cuff.
BACKGROUND
Treating shoulders with osteoarthritis, an intact rotator cuff, and substantial glenoid bone loss is challenging. One option is reaming the glenoid flat and inserting a reverse prosthesis. This study reports the subjective, objective, and radiographic results of reverse total shoulder arthroplasty (RTSA) in this population.


METHODS
We retrospectively reviewed 42 consecutive patients (23 women; mean age, 71 years [range, 53 to 89 years]) with primary glenohumeral osteoarthritis, intact rotator cuffs, and Walch type-A2 (n = 19), B2 (n = 5), or C glenoids (n = 18) who had undergone a total of 42 RTSAs with glenoid reaming without bone-grafting between 2008 and 2013 (mean follow-up, 36 months [range, 24 to 66 months]). All patients were evaluated before and after surgery subjectively (using a visual analog scale for pain and 5 shoulder-specific outcome instruments), objectively (with goniometric examination of shoulder range of motion), and radiographically (to assess baseplate loosening and degree of scapular notching).


RESULTS
One baseplate (2%) failed, requiring revision surgery. There were no other signs of baseplate loosening in any patient at the last follow-up. Preoperatively to postoperatively, pain improved significantly (p < 0.001), as did all patient-reported outcome measures and the following range-of-motion parameters (p ≤ 0.001): active abduction, active flexion, and active external rotation with the arm elevated 90°. Eight (19%) of the patients had notching.


CONCLUSIONS
RTSA without bone-grafting and with medialization of the baseplate in patients with osteoarthritis and severe glenoid bone loss resulted in significant improvement in pain and function with reliable short-term implant survivorship and may be a good alternative to anatomical TSA. Longer follow-up is needed to determine the relative advantages and disadvantages. This was an "off-label" indication for this device.


METHODS
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Edward G
EG
McFarland
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Gazi
G
Huri
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Yoon Suk
YS
Hyun
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Steve A
SA
Petersen
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.
Uma
U
Srikumaran
D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder / Q000379:methods*; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery; D012540:Scapula / Q000000981:diagnostic imaging / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome