Structural Bone Grafting for Glenoid Bone Loss in Primary Anatomic Total Shoulder Arthroplasty: A Case Series and Technique Report

Introduction Posterior glenoid bone loss in glenohumeral osteoarthritis poses significant challenges in shoulder arthroplasty. Anatomic total shoulder arthroplasty with a humeral head autograft to address the glenoid bone deficiency is an option for these difficult cases. Variable results with this procedure are reported in the literature. This article describes the surgical technique of posterior glenoid bone grafting in TSA using a glenoid implant with hybrid fixation, and a series of reported patient functional and radiographic outcomes. Materials and Methods A retrospective chart review of cases from 2015 to 2020 by a single surgeon revealed 10 patients who underwent primary TSA with hybrid glenoid component and posterior glenoid bone grafting. Preoperative and postoperative radiographs were assessed for glenoid inclination, glenoid version, acromiohumeral distance, humeral stem status, and glenoid implant status. Functional outcomes were evaluated by range of motion, strength, and patient-reported clinical outcomes (pain and function on a visual analog scale, disabilities of the arm, shoulder, and hand score, single assessment numeric evaluation, American Shoulder and Elbow Surgeons score). Complications and reoperations were also evaluated. Results Average follow-up was 31.4 months, active forward flexion and external rotation improved on average from 105o to 150o and 20o to 60o, respectively (P<0.001) and average abduction improved from 100o to 140o (P<0.002). At an average of 26.7 months, patients reported assessments (VAS pain and function, QuickDASH, SANE, ASES scores) reveal significant (P<0.05) improvement in pain and functional outcomes. Radiographically, at 23.0 ± 20.1 months, all patients demonstrated a well fixed humeral and glenoid component without evidence of lucent lines. The bone graft used in each patient was well unionized and no radiographic complications were reported. No patients underwent revision surgery, and there was one clinical complication reported, which consisted of a suspected rotator cuff injury at follow-up. Conclusion Hybrid fixation with structural glenoid bone grafting in TSA resulted in excellent outcomes with no evidence of graft or component failure on follow-up radiographs and significantly reduced pain, improved functional scores, and improved active ROM.