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The following is a summary of “Outcomes following Humeral Head Autograft Glenoid Reconstruction in Primary Reverse Total Shoulder Arthroplasty,” published in the August 2024 issue of Surgery by Guareschi et al.

Patients with severe glenoid bone loss face heightened risks of suboptimal implant fixation, scapular notching, dislocation, joint kinematic disturbances, and prosthetic failure following reverse total shoulder arthroplasty (rTSA). While glenoid bone grafting has demonstrated utility in rTSA for patients with inadequate glenoid bone stock, the existing literature on this approach remains limited. This study aims to evaluate the clinical outcomes of primary rTSA with one-stage glenoid reconstruction using a humeral head autograft in patients presenting with significant glenoid deformity.

A retrospective review of a prospectively collected database identified 40 patients who underwent primary rTSA with humeral head autograft between 2008 and 2020, performed by six high-volume shoulder arthroplasty surgeons, with a minimum follow-up of two years. The study assessed various factors: demographics, medical comorbidities, range of motion (ROM), Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain score, patient satisfaction, glenoid deformity, revisions, and complications. The preoperative glenoid deformity was characterized using the glenoid version and beta-angles obtained from computed tomography (CT). Outcomes were compared to a matched control group of 120 patients undergoing standard primary rTSA. Statistical significance was determined with an adjusted alpha value of 0.004 following the post hoc Bonferroni correction.

The mean follow-up for the 40 patients was 5.3 years (range, 2.0-13.2 years). Preoperative assessments revealed a mean glenoid retroversion of 29° and a beta-angle of 80°. At the final follow-up, patients who received the humeral head autograft demonstrated lower mean active external rotation (25° vs. 39°; p = 0.001) than controls. No significant differences were observed in active abduction (p = 0.029), active forward elevation (p = 0.009), active internal rotation (p = 0.147), passive external rotation (p = 0.082), Global Shoulder Function score (p = 0.157), Constant score (p = 0.036), ASES score (p = 0.009), or pain score (p = 0.186) between groups. Complications were noted in 17.5% of patients, with aseptic glenoid loosening being the most prevalent (15%).

This study indicates that primary rTSA with autogenous humeral head autograft for severe glenoid deficiency yields postoperative improvements in ROM and functional outcomes that surpass the minimal clinically important difference and substantial clinical benefit, though these outcomes remain inferior to those of matched controls. Using a resected humeral head autograft represents a viable strategy for managing primary rTSA in patients with significant glenoid deformity.

Source: sciencedirect.com/science/article/abs/pii/S105827462400572X