Posterior open wedge osteotomy of the scapula neck for the treatment of advanced shoulder osteoarthritis with posterior head migration in young patients.
BACKGROUND
Treatment of young, active patients with symptomatic glenohumeral osteoarthritis, excessive glenoid retroversion, and static posterior humeral subluxation is challenging. Correction of glenoid retroversion may lead to centric loading and perhaps recenter the humeral head. We describe the functional and radiologic outcomes after corrective osteotomy of the glenoid in this population of patients.


METHODS
In this retrospective study, we included 10 shoulders (8 patients) that were observed for a mean of 33.4 months (range, 24-52 months) after corrective osteotomy of the glenoid. The mean age at surgery was 41.5 years (range, 24-51 years). On standardized axial images, glenoid retroversion and posterior static humeral subluxation were measured preoperatively and postoperatively and at the final follow-up. At final follow-up, anterior and posterior axial radiographs were performed to determine humeral head position in different arm positions. Clinical follow-up included Constant-Murley score, subjective shoulder value, and patient satisfaction.


RESULTS
The mean Constant-Murley score improved significantly from 45.1 points (range, 24-71) to 64.1 points (range, 44-92; P < .001). The average degree of anterior flexion improved significantly from 117° (range, 50°-160°) to 143° (range, 110°-180°; P = .006). The mean glenoid retroversion changed from 16° (range, 11°-31°) preoperatively to 5° (range, 13° anteversion-16° retroversion; P = .003) at the final follow-up. The mean posterior static subluxation of the humeral head changed from 5 mm (range, 0-10 mm) preoperatively to 6 mm (range, 0-14 mm; P = .259) at the final follow-up.


CONCLUSIONS
This study shows that posterior open wedge osteotomy of the glenoid neck provides excellent correction of glenoid retroversion.
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria. Electronic address: r.ortmaier@gmail.com.
Reinhold
R
Ortmaier
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
Philipp
P
Moroder
Department of Pediatric and Adolescent Surgery, Paracelsus Medical University, Salzburg, Austria.
Corinna
C
Hirzinger
Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
Herbert
H
Resch
D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012540:Scapula / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
Glenoid cavity; arthritis; glenohumeral subluxation; open wedge osteotomy; retroversion; scapula neck