Fate of large structural allograft for treatment of severe uncontained glenoid bone deficiency

ArticleinJournal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 21(6):765-71 · February 2012with10 Reads
DOI: 10.1016/j.jse.2011.08.069 · Source: PubMed
Abstract
Structural allografts have been used for management of large defects of the glenoid. We describe a surgical technique for graft preparation and the radiographic and clinical results of a series of patients using this technique. In 19 consecutive patients, a polymethyl methacrylate mold was used to shape a single graft from a fresh-frozen femoral head to press fit within the glenoid defect. We evaluated the clinical and radiographic results with a minimum 2-year follow-up or until revision to another total shoulder replacement. Six patients showed more than 50% resorption of the graft. Four of these six patients also had less than 50% graft incorporation, and these findings were associated with a less favorable clinical outcome. In 3 of 6 cases in which poly-L-lactic acid bioresorbable screws were used, a significant giant cell reaction was noted at the time of revision surgery. Seven of nine patients with metal screw fixation had bent, broken, or worn screws because of graft collapse and contact with the prosthetic humeral head. Four of the five revision cases that were converted to a reverse total shoulder replacement had sufficient bone incorporation and volume of bone to allow for secure glenoid and screw fixation. The surgical technique described is useful in creation of a well-fitting graft. The amount of bone resorption and bone incorporation and clinical outcome have wide variability. In those cases where revision was performed with another total shoulder replacement, there was sufficient bone incorporation and sufficient bone mass to allow component fixation.
    • "By filling up the defects, the glenoid is restored to its anatomical morphology hence returning the stability of the joint. While several techniques in bone grafting have been reported [14][15][16], the use of autogenous bone graft carries the risk of donor site morbidities (4). Coracoid transfers, such as the Latarjet procedure, increases the stability a bit more than required by the normal shoulder. "
    [Show abstract] [Hide abstract] ABSTRACT: The glenohumeral joint has the most mobility of any in the body, and contact between the humeral head and glenoid labrum contributes to its stability. Patients with recurrent dislocations may have bone defects in one or both of these surfaces, due to the presence of a Bankart lesion or an engaging Hill-Sachs lesion. We present a case of an adult whose left shoulder required intervention following a 10-year history of chronic, recurrent glenohumeral dislocation. Our assessment revealed a large Bankart lesion combined with a large Hill-Sachs lesion. We performed an open surgery with bone augmentation of the glenoid osseous defect using a tricortical autogenous bone graft harvested from the iliac crest. Intra-operative assessment showed adequate stability without intervention for the humeral head defect. The technical aspect of the surgery is described together with the clinical outcomes of the patient. We briefly review therapeutic options for glenohumeral osseous defects described in the literature.
    Full-text · Article · Jun 2016 · Current Reviews in Musculoskeletal Medicine
    • "Another limitation relates to the difficulty to assess the glenoid-diameter on CT scan because of the metallic artifacts created by the humeral component. Additionally, graft incorporation was measured according to Iannotti's technique [11], but the reliability of this technique has not been verified. Finally, no preoperative CT evaluation was available for 45 % of the patients followed-up, which significantly restricted the ability to compare the preoperative and postoperative data. "
    [Show abstract] [Hide abstract] ABSTRACT: Extensive glenoid bone loss after failed shoulder arthroplasty represents a challenge for revision arthroplasty. Treatment options vary widely and have been a source of controversy among experts. Between 2004 and 2010, a total of 17 patients underwent glenoid reconstruction surgery using an autologous iliac crest bone graft and secondary revision arthroplasty due to extensive glenoid bone loss after failed previous total shoulder arthroplasty. The outcomes were assessed by means of clinical examination, Constant score, and bi-plane radiography as well as pre-, postoperative and follow-up CT. Before the revision surgery, the mean Constant score was 24 ± 17 and improved to 40 ± 13 after the glenoid rebuilding and revision arthroplasty. CT imaging revealed adequate glenoid bone stock restoration with no relevant graft resorption or loosening of the glenoid. The average postoperative antero-posterior diameter of the glenoid was 28 ± 3 mm which had decreased to 25 ± 3 mm at follow-up. The average postoperative version of the glenoid was 95.7° ± 6° and had decreased to 98.5° ± 4° at follow-up. Both the glenoid version and diameter had changed significantly (P < 0.001) comparing postoperative and follow-up CT-scans. Glenoid reconstruction surgery using an iliac crest bone-block autograft prior to revision arthroplasty represents a valuable salvage procedure in cases of extensive glenoid bone loss after primary shoulder arthroplasty. Sufficient glenoid bone stock restoration is indispensable for reliable fixation of glenoid components and in turn a satisfactory clinical outcome.
    Article · Dec 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Bone loss is commonly observed in shoulders with anterior instability. The Latarjet procedure is commonly performed when a glenoid bony defect exists that is greater than 25 % of the glenoid width or when the risk of recurrent instability is higher (i.e., collision-sport athletes). Hill-Sachs lesions need to be assessed as well. For the purpose of assessing the bipolar lesions, the glenoid track concept is useful. A Hill-Sachs lesion that is located more medially than the medial margin of the glenoid track is defined as an engaging Hill-Sachs lesion. A potential treatment for such a condition is remplissage, but this procedure also decreases range of motion. Thus, its application in overhead athletes needs to be carefully considered.
    Article · Jan 2013
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