Abstract：
BACKGROUND: Revision shoulder arthroplasty often requires management of glenoid bone defects. Options include using allograft, harvesting iliac crest autograft, or using augmented metal components. The purpose of this study is to report outcomes of revision shoulder arthroplasty requiring management of glenoid bone defects with femoral head allograft in a large cohort of patients using a single reverse shoulder implant system and compare them to a matched cohort based on the indication for surgery. Outcomes of patients who had successful glenoid reconstruction were compared to those that required a re-revision, and to a control group that was revised without the need for bone graft.
METHODS: This was a retrospective review of data collected from 2009 to 2018. There were 36 patients in the bone graft group and 52 in the control group. All patients underwent revision to a reverse shoulder arthroplasty to manage a failed total shoulder arthroplasty (n = 29 and 11), hemiarthroplasty (n = 1 and 24), or reverse shoulder arthroplasty (n = 6 and 17). All patients had a minimum of 2 yr of clinical follow-up. The primary endpoint was survival of baseplate fixation. Secondary outcomes included range of motion and functional outcome scores. Patients that had recurrent baseplate failure and were re-revised were compared to patients with bone graft that did not require additional surgery, and to patients who were revised without the need for bone graft. Patients who required revisions for reasons other than recurrent baseplate failure were also recorded.
RESULTS: Five of 36 (14%) patients had recurrent baseplate failure. Mean time to failure was 12 mo. Three of 5 had successful re-implantation of another baseplate. Two of 5 were revised to a hemi arthroplasty after failure of their revisions. Preoperative American Shoulder and Elbow Surgeons scores were 31 in the grafted patients that did not require re-revision, 39 in the grafted patients that required re-revision, and 33 in the control group. Final American Shoulder and Elbow Surgeons scores were 64, 36, and 56, respectively. One patient required revision surgery not related to baseplate failure. There were no baseplate failures in the control group.
CONCLUSIONS: The use of femoral head allograft to manage glenoid bone defects in the revision setting produces predictable improvement in functional outcomes that is not inferior to those in patients revised without bone graft. However, there is a 14% rate of baseplate failure.
METHODS: This was a retrospective review of data collected from 2009 to 2018. There were 36 patients in the bone graft group and 52 in the control group. All patients underwent revision to a reverse shoulder arthroplasty to manage a failed total shoulder arthroplasty (n = 29 and 11), hemiarthroplasty (n = 1 and 24), or reverse shoulder arthroplasty (n = 6 and 17). All patients had a minimum of 2 yr of clinical follow-up. The primary endpoint was survival of baseplate fixation. Secondary outcomes included range of motion and functional outcome scores. Patients that had recurrent baseplate failure and were re-revised were compared to patients with bone graft that did not require additional surgery, and to patients who were revised without the need for bone graft. Patients who required revisions for reasons other than recurrent baseplate failure were also recorded.
RESULTS: Five of 36 (14%) patients had recurrent baseplate failure. Mean time to failure was 12 mo. Three of 5 had successful re-implantation of another baseplate. Two of 5 were revised to a hemi arthroplasty after failure of their revisions. Preoperative American Shoulder and Elbow Surgeons scores were 31 in the grafted patients that did not require re-revision, 39 in the grafted patients that required re-revision, and 33 in the control group. Final American Shoulder and Elbow Surgeons scores were 64, 36, and 56, respectively. One patient required revision surgery not related to baseplate failure. There were no baseplate failures in the control group.
CONCLUSIONS: The use of femoral head allograft to manage glenoid bone defects in the revision setting produces predictable improvement in functional outcomes that is not inferior to those in patients revised without bone graft. However, there is a 14% rate of baseplate failure.
摘要：
背景：肩关节置换术通常需要治疗关节盂骨缺损。选项包括使用同种异体移植，收获髂骨自体移植，或使用增强的金属构件。这项研究的目的是报告在使用单个反向肩关节植入系统的大型患者队列中，需要使用股骨头同种异体移植治疗关节盂骨缺损的翻修肩关节置换术的结果，并根据手术指征将其与匹配的队列进行比较。将成功进行关节盂重建的患者的结果与需要重新修订的患者进行比较，以及不需要植骨的对照组。
方法：这是对2009年至2018年收集的数据的回顾性回顾。植骨组36例，对照组52例。所有患者都接受了反向肩关节置换术的翻修，以治疗失败的全肩关节置换术（n=29和11），半髋关节置换术（n=1和24），或反向肩关节置换术（n=6和17）。所有患者都有至少2年的临床随访。主要终点是底板固定的存活率。次要结果包括运动范围和功能结果评分。将反复发生基板衰竭并重新修正的患者与不需要额外手术的植骨患者进行比较，以及不需要植骨的患者。还记录了因复发性基板失败以外的原因而需要进行修正的患者。
结果：36例患者中有5例（14%）反复出现底板衰竭。平均失败时间为12个月。5人中有3人成功地重新植入了另一块基板。修订失败后，有5个中的2个被修订为半关节成形术。术前ASES评分在不需要重新修订的移植患者中为31，39在需要重新修订的嫁接患者中，对照组为33。最终的ASES评分分别为64、36和56。一名患者需要与基板故障无关的翻修手术。对照组没有基板故障。
结论：在翻修设置中使用股骨头同种异体移植来处理关节盂骨缺损可预测地改善功能结局，其效果不亚于未进行骨移植的患者。然而,基板故障率为14%。
方法：这是对2009年至2018年收集的数据的回顾性回顾。植骨组36例，对照组52例。所有患者都接受了反向肩关节置换术的翻修，以治疗失败的全肩关节置换术（n=29和11），半髋关节置换术（n=1和24），或反向肩关节置换术（n=6和17）。所有患者都有至少2年的临床随访。主要终点是底板固定的存活率。次要结果包括运动范围和功能结果评分。将反复发生基板衰竭并重新修正的患者与不需要额外手术的植骨患者进行比较，以及不需要植骨的患者。还记录了因复发性基板失败以外的原因而需要进行修正的患者。
结果：36例患者中有5例（14%）反复出现底板衰竭。平均失败时间为12个月。5人中有3人成功地重新植入了另一块基板。修订失败后，有5个中的2个被修订为半关节成形术。术前ASES评分在不需要重新修订的移植患者中为31，39在需要重新修订的嫁接患者中，对照组为33。最终的ASES评分分别为64、36和56。一名患者需要与基板故障无关的翻修手术。对照组没有基板故障。
结论：在翻修设置中使用股骨头同种异体移植来处理关节盂骨缺损可预测地改善功能结局，其效果不亚于未进行骨移植的患者。然而,基板故障率为14%。
