Printer Friendly

Bone grafting the glenoid versus use of augmented glenoid baseplates with reverse shoulder arthroplasty.

Glenoid deficiency is a common occurrence in patients undergoing shoulder arthroplasty. It has been reported that 39% of patients with rotator cuff tear arthropathy (CTA) will have acquired glenoid defects. (1,2) Adverse consequences can occur from implantation of a reverse total shoulder arthroplasty (rTSA) in patients with severely eroded glenoids. Excessive medialization of the implants can lead to muscle shortening and inferomedial impingement causing scapular notching resulting in bone erosion and polyethylene wear. (3-6) Superior tilting of the glenoid baseplate can increase the risk of aseptic loosening, increase shear forces, and decrease the stabilizing compressive forces of the reverse shoulder implant. (7-10) Furthermore, excessive glenoid wear medializes the humerus, which can decrease deltoid wrapping around the greater tuberosity leading to instability as well as cosmetic issues in some patients (5,6) (Fig. 1).

Options to address glenoid bone loss with rTSA include eccentric reaming, bone grafting, and the use of augmented glenoid baseplates. Eccentric reaming is non-ideal as it requires removal of additional glenoid bone and further medializes the joint line. (11-13) The benefits of augmented baseplates include the ability to correct deformity without eccentric reaming, thereby preserving bone stock and avoiding glenoid bone grafting, which adds time and difficulty to the case. (10,14) Glenoid bone grafting also produces greater costs and adds another potential site of failure if the graft does not incorporate. (15-18) The purpose of this study is to compare the outcomes of rTSA in patients with large glenoid defects corrected using either structural bone graft behind the glenoid baseplate or augmented glenoid baseplates. We hypothesized that both options would achieve improved clinical outcomes, and that there would be no difference in outcomes between the two cohorts.

Methodology

An international multicenter data registry was utilized. Preoperative and postoperative data was analyzed from 80 patients with glenoid bone loss (average age: 71.6 years) with a minimum of 2-years follow-up (average follow-up: 31.2 months) and underwent primary rTSA using either an augmented glenoid baseplate (cohort composed of 24 patients with a 8[degrees] posterior augment baseplate and 15 patients with a 10[degrees] superior augment baseplate) or a glenoid bone graft placed behind the baseplate (cohort composed of 5 patients with allograft and 36 patients with autograft) to obtain glenoid fixation in an eroded scapula. All grafts were used to correct glenoid deficiencies, not to lateralize the center of rotation. Thirty-nine patients (14 female, average age: 73.1 years; 25 male, 71.5 years) received the Equinoxe[R] rTSA shoulder with an augmented baseplate for treatment of CTA, RCT, or OA with a glenoid defect (average age: 72.1 [+ or -] 8.5 years). Forty-one patients (27 female, average: 73.0 years; 14 male, average: 66.9 years) received the Equinoxe[R] rTSA shoulder with glenoid bone graft for treatment of CTA, RCT, and OA with a glenoid defect (average age: 71.2 [+ or -] 7.6 years).

Each patient was scored preoperatively and at latest follow-up using the SST, UCLA, ASES, Constant, and SPADI metrics; additionally, active abduction, forward flexion, and active and passive external rotation with the arm at the side were measured. Internal rotation was also measured by vertebral segments and was scored by the following discrete assignment: 0[degrees] = 0, hip = 1, buttocks = 2, sacrum = 3, L5-L4 = 4, L3-L1 = 5, T12-T8 = 6, and T7 or higher = 7. The average follow-up for rTSA patients with an augmented baseplate was 28.3 [+ or -] 5.7 months, and the average follow-up for rTSA patients with glenoid bone graft was 34.1 [+ or -] 15.0 months. A Student's two-tailed, unpaired t-test was used to identify differences in preoperative and postoperative results, where p < 0.05 denoted a significant difference.

Results

All patients demonstrated significant improvements in pain and function following treatment with rTSA using either augmented glenoid baseplates or glenoid bone graft to correct the glenoid defects (Tables 1 and 2). The database contained 0 complications (0%) for the rTSA patients with an augmented glenoid baseplate and six complications (14.6%) for the rTSA patients with glenoid bone graft (including two glenoid loosenings and graft failures). Radiographic follow-up was available for 30 of 39 augmented baseplate patients (76.9%) and 27 of 41 bone graft patients (65.9%). The augmented baseplate rTSA cohort had a scapular notching rate of 10.0% (all three patients had grade 1 notches); whereas, the glenoid bone graft rTSA cohort had a scapular notching rate of 18.5% (all five patients had grade 1 notches). The average preoperative, postoperative, and pre- to postoperative improvement for each cohort are presented in Tables 3, 4, and 5, respectively. As described in Tables 4 and 5, patients with augmented baseplates and patients with glenoid bone graft were associated with statistically equivalent preoperative, postoperative, and pre- to postoperative improvement in each clinical metric scores and range of motion measurement; the only observed statistical difference between the two cohorts is that the bone graft group was associated with a significantly higher complication rate (0% vs. 14.6%, p = 0.0126).

Discussion

The results of this study suggest that either augmented glenoid baseplates or glenoid bone graft can be used to address large glenoid defects during rTSA with significant improvement in outcomes; however, augmented glenoid baseplates were associated with a significantly lower complication and scapular notching rates. Severe glenoid defects that result from bone erosion or trauma sequelae frequently pose a difficult treatment dilemma in patients undergoing shoulder arthroplasty. (19-23) Walch and coworkers developed the most commonly used classification system for glenoid erosion. (24) Type A glenoids have centered humeral heads with either minor (type A1) or major (type A2) glenoid erosion. This was the most common type at 59% in their series. Type B glenoids, the next most common type, consist of posterior subluxation of the humeral head. Type B1 glenoids contain posterior subluxation with no erosion. Type B2 involve posterior erosion with a biconcave glenoid. Type C glenoids involve severe erosion (greater than 25[degrees]) and are considered hypoplastic. Building upon this work, Favard and colleagues created a classification system to describe glenoid wear in patients with rotator cuff tear arthropathy. (25) Grade E0 have no wear, E1 have concentric wear, E2 have superior wear, and E3 glenoids have superior and inferior glenoid erosion. Options to address glenoid wear include hemiarthroplasty avoiding the use of a glenoid implant, eccentric reaming, augmented implants, and in cases where more correction is needed, bone grafting. Glenoid bone grafting with shoulder arthroplasty has been described with autograft humeral head, iliac crest, or allograft femoral head. (26-32) Advantages of this technique include maintenance of the joint line and preservation of glenoid bone stock. Disadvantages include technical difficulty, fixation failure, and graft resorption, which could secondarily lead to component loosening. (15-18)

Numerous studies have reported the results of bone grafting with rTSA in the treatment of the deficient glenoid with encouraging short-term outcomes. (33-37) Neyton and associates reported on nine patients who underwent glenoid bone graft with either autograft humeral head or iliac crest combined with rTSA34; Constant scores, ROM, and pain scores improved in all patients, and no instances of radiographic loosening occurred at 2-year follow-up. Boileau and coworkers described the use of humeral head autograft to improve lateralization of the center of rotation. (35) They used a 7 mm to 10 mm graft and an extended post on the baseplate and reported a 98% incorporation rate with no loosening or revisions at 28 months. (35) These patients did not require glenoid grafting for glenoid defects, however, and may not be comparable to this study. Melis and colleagues evaluated 37 anatomic TSAs requiring revision to rTSA. They reported that 29 of these patients required bone grafts consisting of structural iliac crest or cancellous autograft and 3 allografts. (36) Seventy-six percent of the grafts incorporated at mean follow-up of 47 months with a complication rate of 30% and a 22% re-revision rate. Werner and associates reported on rTSA for long standing anterior shoulder dislocation with severe anterior glenoid bone loss. (37) They evaluated 21 patients, each of whom received a humeral head autograft on the glenoid. At latest follow-up, all patients showed improvement in functional scores; two graft failures occurred, where one of which was thought to be related to the use of a peg that was too short. (37)

Use of augmented glenoid implants may be an attractive alternative to bone grafting significant glenoid defects. (10,14) Several studies have reported on the use of augmented implants in primary anatomic TSA with variable clinical results. (38-40) While additional clinical follow-up is required to demonstrate the clinical viability of these augmented implants, numerous recent biomechanical studies have demonstrated substantial rationale for these devices to preserve glenoid bone, improve stress transmission to increase the potential for long-term fixation, and improve muscle tensioning with total shoulder arthroplasty. (41-44) No studies exist in the literature regarding use of augmented glenoid baseplates clinically in rTSA applications. Roche and coworkers reported on biomechanical test results of a superior augmented glenoid baseplate versus eccentric reaming with a standard baseplate to correct simulated Favard E2 superiorly worn glenoids with rTSA. (10) After cyclic testing, there was no difference in fixation and displacement between the standard baseplate and the superior augmented baseplate, and the superior augmented baseplate was observed to conserve significantly more bone than the standard baseplate with eccentric reaming. It should be noted that this rTSA glenoid test method has been utilized previously to demonstrate that rTSA baseplates with bone graft (using the BIO-RSA technique) had significantly poorer fixation than rTSA glenoid baseplates without bone graft. (45) Posterior augmented glenoids have also been shown to better restore posterior rotator cuff muscle tensioning with rTSA than use of rTSA with standard baseplates. (46)

Currently, three types of augmented rTSA baseplates are available: 10[degrees] superior augment, 8[degrees] posterior augment, and combined 10[degrees] superior/8[degrees] posterior augment; a +10 mm extended cage baseplate is also available to facilitate bone grafting of medially eroded glenoids (Exactech, Inc., Gainesville, FL) (Fig. 2). To our knowledge, this is the first comparative outcome study presenting clinical results using augmented baseplates versus use of bone graft to correct glenoid deformities with rTSA. In both cohorts, significant improvements were observed in pain, ROM, and outcome metrics at 2-years minimum follow-up. This offering of augmented implants permits the surgeon to address certain glenoid defects while preserving glenoid bone stock without the use of bone graft. The use of prosthetic augments eliminates the technical difficulties commonly encountered when utilizing structural bone graft for large glenoid defects, as evidenced by the significantly different complication rates observed in this study (0% versus 14.6%, p = 0.0126). These complications included two patients with aseptic baseplate loosening, two with intraoperative humeral fractures, one infection, and one patient with persistent pain. The augmented baseplate cohort also demonstrated a lower scapular notching rate than the bone graft cohort (10% versus 18.5%); in both groups, only grade 1 notching was observed. Perhaps these differences result from the increased technical difficulty of fashioning the bone grafts and properly placing the standard implants, potentially leading to less than optimum implant positioning with resultant scapular notching. Other potential benefits of augmented glenoid baseplates include lower surgical costs, shorter operating time, and less patient morbidity by avoiding the use of allografts, fashioning grafts, or at times, harvesting iliac crest autografts.

This study has several limitations. Data was collected from a multi-center database with multiple surgeons rather thanjust one surgeon and site. This study structure introduces some possible inconsistencies. First, we are unable to determine what criteria each surgeon used to determine when to use an augmented implant versus a bone graft. Many of the bone grafts were used prior to the availability of augmented baseplates, however, leading us to believe the criteria were similar for each group. Furthermore the database does not contain data indicating if preoperative CT scans were used in all cases to determine the amount of deficiency. Nonetheless, each of the six surgeons with cases in this data set were experienced and fellowship-trained; therefore, minimizing the chances that grafts or augments were used inappropriately. Additionally, no differentiation was made between grafts or augments used for eccentric glenoid defects and concentric defects. This comparison may show different outcomes and is an area for future study. Finally, no statistical comparisons are made between the different augmented implant and bone graft sub-groups (e.g., superior augment baseplate or posterior augment baseplates versus allograft or autograft) due to insufficient sample sizes; instead, the graft and augment subgroups were combined. Future work should assess a larger population with longer follow-up. Glenoid defects should be categorized radiographically prior to surgery, and consistent criteria determined for the use of glenoid grafts or augmented baseplates. Isolating each subgroup may elucidate other differences, as different wear patterns and indications may act as confounders and impart various consequences and outcomes after rTSA.

Conclusion

In conclusion, both the use of augmented baseplates and glenoid bone graft to correct significant glenoid wear with rTSA can improve clinical outcomes at 2-years minimum follow-up. In the authors' experience, the use of bone grafts is more technically demanding and leads to higher complication and scapular notching rates compared to using augmented glenoid baseplates with rTSA. Further study is required to elucidate the best treatment option for reconstructing these difficult glenoids when rTSA is the treatment of choice.

Conflict of Interest Statement

Richard B. Jones, M.D., is a consultant for Exactech Inc., Gainesville, Florida. Thomas W. Wright, M.D., is a consultant for and receives royalties from Exactech, Inc., Gainesville, Florida. Christopher P. Roche, M.S., is an employee of Exactech, Inc., Gainesville, Florida.

References

(1.) Frankle MA, Teramoto A, Luo ZP, et al. Glenoid Morphology in reverse shoulder arthroplasty: classification and surgical implications. J Shoulder Elbow Surg. 2009 NovDec; 18(6):874-85.

(2.) Klein SM, Dunning P, Mulieri P, et al. Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse total shoulder arthroplasty. J Bone Joint Surg Am. 2010 May; 92(5):1144-54.

(3.) Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae and revision arthroplasty. J Shoulder Elbow Surg. 2006 Sep-Oct; 15:527-40.

(4.) Gerber C, Pennignton SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009 May; 17(5):828495.

(5.) Roche CP, Diep P, Hamilton M, et al. Impact of inferior glenoid tilt, humeral retroversion, bone grafting, and design parameters on muscle length and deltoid wrapping in reverse shoulder arthroplasty. Bull Hosp Jt Dis (2013). 2013; 71(4):284-93.

(6.) Roche C, Diep P, Hamilton M, et al. Biomechanical analysis of 3 commercially available reverse shoulder designs in a normal and medially eroded scapula. Presented at the 59th Annual Orthopaedic Research Society Meeting. San Antonio, Texas, January 26-29, 2013.

(7.) Frankle MA, Siegal S, Pupello DR, et al. Coronal plane tilt angle affects risk of catastrophic failure in patients treated with a reverse shoulder prosthesis. J Shoulder Elbow Surg. 2007; 16:e46.

(8.) Gutierrez S, Greiwe RM, Frankle MA, et al. Biomechanical comparison of component position and hardware failure in the reverse shoulder prosthesis. J Shoulder Elbow Surg. 2007 May-Jun; 16(3 Suppl):S9-S12.

(9.) Gutierrez S, Walker M, Willis M, et al. Effects of tilt and glenosphere eccentricity on baseplate/bone interface forces in a computational model, validated by a mechanical model, of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2011 Jul; 20(5):732-9.

(10.) Roche CP, Stroud NJ, Martin BL, et al. Achieving fixation in glenoids with superior wear using reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2013 Dec; 22(12):1695-701.

(11.) Clavert P, Millett PJ, Warner JJ. Glenoid resurfacing: what are the limits to asymmetric reaming for posterior erosion? J Shoulder Elbow Surg. 2007 Nov-Dec; 16(6):843-8.

(12.) Gillespie R, Lyons R, Lazarus M. Eccentric reaming in total shoulder arthroplasty: a cadaveric study. Orthopedics. 2009 Jan; 32(1):21.

(13.) Nowak DD, Bahu MJ, Gardner TR, et al. Simulation of surgical glenoid resurfacing using three-dimensional computed tomography of the arthritic glenohumeral joint: the amount of glenoid retroversion that can be corrected. J Shoulder Elbow Surg. 2009 Sep-Oct; 18(5):680-8.

(14.) Gilot GJ. Addressing glenoid erosion in reverse total shoulder arthroplasty. Bull Hosp Jt Dis (2013). 2013; 71 Suppl 2:S51-3. Review.

(15.) Neyton L, Boileau P, Nove-Josserand L, et al. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007 May-Jun; 16(3 Suppl):S71-8.

(16.) Bateman E, Donald SM. Reconstruction of massive uncontained glenoid defects using a combined autograft-allograft construct with reverse shoulder arthroplasty: preliminary results. J Shoulder Elbow Surg. 2012 Jul; 21(7):925-34.

(17.) Melis B, Bonnevialle N, Neyton L, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elbow Surg. 2012 Mar; 21(3):342-9.

(18.) Boileau P, Moineau G, Roussanne Y, O'Shea K. Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011 Sep; 469(9):2558-67.

(19.) Farron A, Terrier A, Buchler P. Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg. 2006 Jul-Aug; 15(4):521-526.

(20.) Hasan SS, Jordan ML, Campbell B, et al. Characteristics of unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg. 2002 Sep-Oct; 11(5):431-41.

(21.) Iannotti JP, Norris TR: Influence of preoperative factors on outcome of shoulder arthroplasty for Glenohumeral osteoarthritis. J Bone Joint Surg Am. 2003 Feb; 85-A(2):251-8.

(22.) Levine WN, Djurasovic M, Glasson J, et al. Hemiarthroplasty for glenohumeral osteoarthritis: results correlated to degree of glenoid wear. J Shoulder Elbow Surg. 1997 Sep-Oct; 6(5):449-54.

(23.) Shapiro TA, McGarry MH, Gupta R, et al. Biomechanical effects of glenoid retroversion in total shoulder arthroplasty. J Shoulder Elbow Surg. 2007 May-Jun; 16(3 suppl):S90-5.

(24.) Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty. 1999 Sep; 14(6):756-60.

(25.) Huguet D, Favard L, Lautma S, et al. Epidemiology, imaging, and classification of glenohumeral osteoarthritis with massive and non-reparable rotator cuff tear. In: Walch G, Boileau P, Mole D (eds): 2000 Shoulder Prostheses: Two to Ten Year Follow-up. Montpellier: Sauramps Medical, 2001, pp233-240.

(26.) Neer CS II, Morrison DS: Glenoid bone-grafting in total shoulder arthroplasty. J Bone Joint Surg Am. 1988 Sep; 70(8):115462.

(27.) Steinmann SP, Cofield RH. Bone grafting for glenoid deficiency in total shoulder replacement. J Shoulder Elbow Surg. 2000 Sep-Oct; 9(5):361-7.

(28.) Walch G, Moraga C, Young A, Castellanos-Rosas J. Results of anatomic non-constrained prosthesis in primary osteoarthritis with biconcave glenoid. Shoulder Elbow Surg. 2012 Nov; 21(11):1526-33.

(29.) Hill JM, Norris TR. Long-term results of total shoulder arthroplasty following bone-grafting of the glenoid. J Bone Joint Surg Am. 2001 Jun; 83-A(6):877-83.

(30.) Hoffelner T, Moroder P, Auffarth A, et al. Outcomes after shoulder arthroplasty revision with glenoid reconstruction and bone grafting. Int Ortho. 2014 Apr; 38(4):775-82.

(31.) Klika BJ, Wooten CW, Sperling JW, et al. Structural bone grafting for glenoid deficiency in primary total shoulder arthroplasty. J Shoulder Elbow Surg, 2014 Jul; 23(7):1066-72.

(32.) Sabesan V, Callanan M, Ho J, Iannotti JP. Clinical and radiographic outcomes of total shoulder arthroplasty with bone graft for osteoarthritis with severe glenoid bone loss. J Bone Joint Surg Am. 2013 Jul 17; 95(14):1290-6.

(33.) Norris TR, Kelly JD, Humphrey CS. Management of glenoid bone defects in revision shoulder arthroplasty: A new application of the reverse total shoulder prosthesis. Tech Shoulder Elbow Surg. 2007; 8(1):37-46.

(34.) Neyton L, Boileau P, Nove-Josserand L, et al. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007 May-Jun; 16(3):S71-8.

(35.) Boileau P, Moineau G, Roussanne Y, O'Shea K. Bony increased-offset reversed shoulder arthroplasty; minimizing scapular impingement while maximizing glenoid fixation. Clin Orthop Relat Res. 2011 Sep; 469(9):2558-67.

(36.) Melis B, Bonnevialle N, Neyton L, et al. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option? J Shoulder Elbow Surg. 2012 Mar; 21(3):342-9.

(37.) Werner BS, Bohm D, Abdelkawi A, Gohlke F. Glenoid bone grafting in reverse shoulder arthroplasty for long-standing anterior shoulder dislocation. J Shoulder Elbow Surg. 2014 Nov; 23(11):1655-61.

(38.) Neer CS II, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg Am. 1982 Mar; 64(3):319-37.

(39.) Rice RS, Sperling JW, Miletti J, et al. Augmented glenoid component for bone deficiency in shoulder arthroplasty. Clin Orthop Relat Res. 2008 Mar; 466(3):579-83.

(40.) Gunther SB, Lynch TL. Total shoulder replacement surgery with custom glenoid implants for sever bone deficiency. J Shoulder Elbow Surg. 2012 May; 21(5):675-84.

(41.) Roche CP, Diep P, Grey SG, Flurin PH. Biomechanical impact of posterior glenoid wear on anatomic total shoulder arthroplasty. Bull Hosp Jt Dis (2013). 2013; 71 Suppl 2:S5-11.

(42.) Sabesan V, Callanan M, Sharma V, Iannotti IP. Correction of acquired glenoid bone loss in osteoarthritis with a standard versus an augmented glenoid component. J Shoulder Elbow Surg. 2014 Jul; 23(7):964-73.

(43.) Hermida JC, Flores-Hernandez C, Hoenecke HR, D'Lima DD. Augmented wedge-shaped glenoid component for the correction of glenoid retroversion: a finite element analysis. J Shoulder Elbow Surg. 2014 Mar; 23(3):347-54.

(44.) Kersten AD, Flores-Hernandez C, Hoenecke HR, D'Lima DD. Posterior augmented glenoid designs preserve more bone in biconcave glenoids. J Shoulder Elbow Surg. 2015 Jul; 24(7):1135-41.

(45.) Stroud N, DiPaola MJ, Flurin PH, Roche CP. Reverse shoulder glenoid loosening: an evaluation of the initial fixation associated with six different reverse shoulder designs. Bull Hosp Jt Dis (2013). 2013; 71 Suppl 2:S12-7.

(46.) Roche CP, Diep P, Hamilton M, et al. Impact of posterior wear on muscle length with reverse shoulder arthroplasty. Proceedings of the 32nd Annual San Diego Shoulder Course, San Diego, California, June 17-20, 2015.

Richard B. Jones, M.D., Southeastern Sports Medicine, Asheville, North Carolina. Thomas W. Wright, M.D., Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida. Christopher P. Roche, M.S., M.B.A., Exactech, Inc., Gainesville, Florida.

Correspondence: Richard B. Jones, M.D., sportdocrbj@aol.com.

Caption: Figure 1 Joint medialization with glenoid wear shortens the rotator cuff muscles and reduces deltoid wrapping. When performing rTSA, bone grafting or augmented baseplates are recommended to restore the native joint line to improve rotator cuff muscle tension and deltoid wrapping.

Caption: Figure 2 Equinoxe[R] baseplates for eroded glenoids, from left to right: 8[degrees] posterior augment, 10[degrees] superior augment, combined 10[degrees] superior/8[degrees] posterior augment, and +10 mm extended cage peg baseplates (Exactech, Inc. Gainesville, FL).

Table 1 Average Preoperative and Postoperative Outcome Scores,
rTSA Patients with Augmented Baseplates

                                           SST

Preop Augment Avg [+ or -] St Dev    4.1 [+ or -] 3.3
Postop Augment Avg [+ or -] St Dev   9.4 [+ or -] 3.2
P-value                                  < 0.0001

                                           UCLA

Preop Augment Avg [+ or -] St Dev    13.6 [+ or -] 4.2
Postop Augment Avg [+ or -] St Dev   29.5 [+ or -] 6.3
P-value                                  < 0.0001

                                            ASES

Preop Augment Avg [+ or -] St Dev    40.3 [+ or -] 18.6
Postop Augment Avg [+ or -] St Dev   81.7 [+ or -] 20.6
P-value                                    0.0003

                                          Constant

Preop Augment Avg [+ or -] St Dev    34.3 [+ or -] 13.7
Postop Augment Avg [+ or -] St Dev   68.7 [+ or -] 18.4
P-value                                   < 0.0001

                                           SPADI

Preop Augment Avg [+ or -] St Dev    75.5 [+ or -] 23.8
Postop Augment Avg [+ or -] St Dev   28.7 [+ or -] 31.1
P-value                                   < 0.0001

                                                Active
                                               Abduction

Preop Augment Avg [+ or -] St Dev     75.9 [+ or -] 30.1[degrees]
Postop Augment Avg [+ or -] St Dev   105.5 [+ or -] 29.0[degrees]
P-value                                        < 0.0001

                                                Active
                                                Forward
                                                Flexion

Preop Augment Avg [+ or -] St Dev     84.3 [+ or -] 29.3[degrees]
Postop Augment Avg [+ or -] St Dev   128.7 [+ or -] 32.0[degrees]
P-value                                        < 0.0001

                                         Internal
                                         Rotation
                                          Score

Preop Augment Avg [+ or -] St Dev    2.8 [+ or -] 1.6
Postop Augment Avg [+ or -] St Dev   4.4 [+ or -] 1.9
P-value                                   0.0002

                                               Active
                                              External
                                              Rotation

Preop Augment Avg [+ or -] St Dev    14.2 [+ or -] 20.6[degrees]
Postop Augment Avg [+ or -] St Dev   30.8 [+ or -] 16.0[degrees]
P-value                                        0.0003

                                               Passive
                                              External
                                              Rotation

Preop Augment Avg [+ or -] St Dev    27.4 [+ or -] 21.3[degrees]
Postop Augment Avg [+ or -] St Dev   46.6 [+ or -] 16.1[degrees]
P-value                                       < 0.0001

                                           Max
                                          Weight
                                          (lbs)

Preop Augment Avg [+ or -] St Dev    1.6 [+ or -] 3.1
Postop Augment Avg [+ or -] St Dev   9.3 [+ or -] 8.3
P-value                                  < 0.0001

Table 2 Average Preoperative and Postoperative Outcome Scores, rTSA
Patients with Glenoid Bone Graft

                                              SST

Preop Bone Graft Avg [+ or -] St Dev    2.8 [+ or -] 2.6
Postop Bone Graft Avg [+ or -] St Dev   9.0 [+ or -] 3.4
P-value                                     < 0.0001

                                              UCLA

Preop Bone Graft Avg [+ or -] St Dev    12.2 [+ or -] 3.1
Postop Bone Graft Avg [+ or -] St Dev   28.2 [+ or -] 5.7
P-value                                     < 0.0001

                                               ASES

Preop Bone Graft Avg [+ or -] St Dev    35.0 [+ or -] 16.4
Postop Bone Graft Avg [+ or -] St Dev   80.2 [+ or -] 22.5
P-value                                      < 0.0001

                                             Constant

Preop Bone Graft Avg [+ or -] St Dev    30.0 [+ or -] 11.8
Postop Bone Graft Avg [+ or -] St Dev   64.6 [+ or -] 17.2
P-value                                      < 0.0001

                                              SPADI

Preop Bone Graft Avg [+ or -] St Dev    83.2 [+ or -] 22.3
Postop Bone Graft Avg [+ or -] St Dev   28.4 [+ or -] 30.6
P-value                                      < 0.0001

                                                   Active
                                                  Abduction

Preop Bone Graft Avg [+ or -] St Dev     67.0 [+ or -] 27.8[degrees]
Postop Bone Graft Avg [+ or -] St Dev   105.1 [+ or -] 25.4[degrees]
P-value                                           < 0.0001

                                                   Active
                                                   Forward
                                                   Flexion

Preop Bone Graft Avg [+ or -] St Dev     78.5 [+ or -] 27.5[degrees]
Postop Bone Graft Avg [+ or -] St Dev   124.7 [+ or -] 23.9[degrees]
P-value                                           < 0.0001

                                            Internal
                                            Rotation
                                             Score

Preop Bone Graft Avg [+ or -] St Dev    2.5 [+ or -] 1.6
Postop Bone Graft Avg [+ or -] St Dev   4.3 [+ or -] 1.6
P-value                                     < 0.0001

                                                  Active
                                                 External
                                                 Rotation

Preop Bone Graft Avg [+ or -] St Dev    11.4 [+ or -] 22.0[degrees]
Postop Bone Graft Avg [+ or -] St Dev   30.5 [+ or -] 17.3[degrees]
P-value                                           0.0001

                                                  Passive
                                                 External
                                                 Rotation

Preop Bone Graft Avg [+ or -] St Dev    20.7 [+ or -] 21.8[degrees]
Postop Bone Graft Avg [+ or -] St Dev   44.3 [+ or -] 20.8[degrees]
P-value                                          < 0.0001

                                              Max
                                             Weight
                                             (lbs)

Preop Bone Graft Avg [+ or -] St Dev    1.7 [+ or -] 4.8
Postop Bone Graft Avg [+ or -] St Dev   6.7 [+ or -] 7.6
P-value                                      0.0011

Table 3 Comparison of Average Preoperative Measurements, rTSA
Patients with Augment Baseplates and Glenoid Bone Graft

                                             SST

Preop Augment Avg [+ or -] St Dev      4.1 [+ or -] 3.3
Preop Bone Graft Avg [+ or -] St Dev   2.8 [+ or -] 2.6
P-value                                     0.1088

                                             UCLA

Preop Augment Avg [+ or -] St Dev      13.6 [+ or -] 4.2
Preop Bone Graft Avg [+ or -] St Dev   12.2 [+ or -] 3.1
P-value                                     0.1171

                                              ASES

Preop Augment Avg [+ or -] St Dev      40.3 [+ or -] 18.6
Preop Bone Graft Avg [+ or -] St Dev   35.0 [+ or -] 16.4
P-value                                      0.1933

                                            Constant

Preop Augment Avg [+ or -] St Dev      34.3 [+ or -] 13.7
Preop Bone Graft Avg [+ or -] St Dev   30.0 [+ or -] 11.8
P-value                                      0.1519

                                             SPADI

Preop Augment Avg [+ or -] St Dev      75.5 [+ or -] 23.8
Preop Bone Graft Avg [+ or -] St Dev   83.2 [+ or -] 22.3
P-value                                      0.1923

                                                 Active
                                                Abduction

Preop Augment Avg [+ or -] St Dev      75.9 [+ or -] 30.1[degrees]
Preop Bone Graft Avg [+ or -] St Dev   67.0 [+ or -] 27.8[degrees]
P-value                                          0.1742

                                                 Active
                                                 Forward
                                                 Flexion

Preop Augment Avg [+ or -] St Dev      84.3 [+ or -] 29.3[degrees]
Preop Bone Graft Avg [+ or -] St Dev   78.5 [+ or -] 27.5[degrees]
P-value                                          0.3688

                                           Internal
                                           Rotation
                                            Score

Preop Augment Avg [+ or -] St Dev      2.8 [+ or -] 1.6
Preop Bone Graft Avg [+ or -] St Dev   2.5 [+ or -] 1.6
P-value                                     0.3534

                                                 Active
                                                External
                                                Rotation

Preop Augment Avg [+ or -] St Dev      14.2 [+ or -] 20.6[degrees]
Preop Bone Graft Avg [+ or -] St Dev   11.4 [+ or -] 22.0[degrees]
P-value                                          0.5646

                                                 Passive
                                                External
                                                Rotation

Preop Augment Avg [+ or -] St Dev      27.4 [+ or -] 21.3[degrees]
Preop Bone Graft Avg [+ or -] St Dev   20.7 [+ or -] 21.8[degrees]
P-value                                          0.1774

                                             Max
                                            Weight
                                            (lbs)

Preop Augment Avg [+ or -] St Dev      1.6 [+ or -] 3.1
Preop Bone Graft Avg [+ or -] St Dev   1.7 [+ or -] 4.8
P-value                                     0.9179

Table 4 Comparison of Average Postoperative Measurements, rTSA
Patients with Augment Baseplates and Glenoid Bone Graft

                                              SST

Postop Augment Avg [+ or -] St Dev      9.4 [+ or -] 3.2
Postop Bone Graft Avg [+ or -] St Dev   9.0 [+ or -] 3.4
P-value                                      0.6513

                                              UCLA

Postop Augment Avg [+ or -] St Dev      29.5 [+ or -] 6.3
Postop Bone Graft Avg [+ or -] St Dev   28.2 [+ or -] 5.7
P-value                                      0.3553

                                               ASES

Postop Augment Avg [+ or -] St Dev      81.7 [+ or -] 20.6
Postop Bone Graft Avg [+ or -] St Dev   80.2 [+ or -] 22.5
P-value                                       0.7647

                                             Constant

Postop Augment Avg [+ or -] St Dev      68.7 [+ or -] 18.4
Postop Bone Graft Avg [+ or -] St Dev   64.6 [+ or -] 17.2
P-value                                       0.3311

                                              SPADI

Postop Augment Avg [+ or -] St Dev      28.7 [+ or -] 31.1
Postop Bone Graft Avg [+ or -] St Dev   28.4 [+ or -] 30.6
P-value                                       0.9695

                                                   Active
                                                  Abduction

Postop Augment Avg [+ or -] St Dev      105.5 [+ or -] 29.0[degrees]
Postop Bone Graft Avg [+ or -] St Dev   105.1 [+ or -] 25.4[degrees]
P-value                                            0.9504

                                                   Active
                                                   Forward
                                                   Flexion

Postop Augment Avg [+ or -] St Dev      128.7 [+ or -] 32.0[degrees]
Postop Bone Graft Avg [+ or -] St Dev   124.7 [+ or -] 23.9[degrees]
P-value                                            0.5473

                                            Internal
                                            Rotation
                                             Score

Postop Augment Avg [+ or -] St Dev      4.4 [+ or -] 1.9
Postop Bone Graft Avg [+ or -] St Dev   4.3 [+ or -] 1.6
P-value                                      0.6984

                                                  Active
                                                 External
                                                 Rotation

Postop Augment Avg [+ or -] St Dev      30.8 [+ or -] 16.0[degrees]
Postop Bone Graft Avg [+ or -] St Dev   30.5 [+ or -] 17.3[degrees]
P-value                                           0.9455

                                                  Passive
                                                 External
                                                 Rotation

Postop Augment Avg [+ or -] St Dev      46.6 [+ or -] 16.1[degrees]
Postop Bone Graft Avg [+ or -] St Dev   44.3 [+ or -] 20.8[degrees]
P-value                                           0.6110

                                              Max
                                             Weight
                                             (lbs)

Postop Augment Avg [+ or -] St Dev      9.3 [+ or -] 8.3
Postop Bone Graft Avg [+ or -] St Dev   6.7 [+ or -] 7.6
P-value                                      0.1743

Table 5 Comparison of Average Improvement, rTSA Patients with Augment
Baseplates and Glenoid Bone Graft

                                       SST                UCLA

Augment Avg [+ or -] St Dev      5.3 [+ or -] 3.5   15.5 [+ or -] 6.3
Bone Graft Avg [+ or -] St Dev   6.2 [+ or -] 3.8   16.1 [+ or -] 6.1
P-value                               0.3222             0.6875

                                        ASES

Augment Avg [+ or -] St Dev      41.4 [+ or -] 21.0
Bone Graft Avg [+ or -] St Dev   46.2 [+ or -] 21.9
P-value                                0.3309

                                      Constant

Augment Avg [+ or -] St Dev      33.9 [+ or -] 19.1
Bone Graft Avg [+ or -] St Dev   37.0 [+ or -] 19.8
P-value                                0.5060

                                       SPADI

Augment Avg [+ or -] St Dev      46.9 [+ or -] 24.3
Bone Graft Avg [+ or -] St Dev   57.2 [+ or -] 26.7
P-value                                0.1155

                                           Active
                                          Abduction

Augment Avg [+ or -] St Dev      29.2 [+ or -] 27.2[degrees]
Bone Graft Avg [+ or -] St Dev   40.3 [+ or -] 35.7[degrees]
P-value                                    0.1476

                                           Active
                                           Forward
                                           Flexion

Augment Avg [+ or -] St Dev      43.9 [+ or -] 33.6[degrees]
Bone Graft Avg [+ or -] St Dev   47.3 [+ or -] 36.3[degrees]
P-value                                    0.6842

                                     Internal
                                     Rotation
                                      Score

Augment Avg [+ or -] St Dev      1.6 [+ or -] 2.2
Bone Graft Avg [+ or -] St Dev   1.9 [+ or -] 1.8
P-value                               0.5764

                                           Active
                                          External
                                          Rotation

Augment Avg [+ or -] St Dev      16.4 [+ or -] 21.2[degrees]
Bone Graft Avg [+ or -] St Dev   20.6 [+ or -] 22.6[degrees]
P-value                                    0.4207

                                           Passive
                                          External
                                          Rotation

Augment Avg [+ or -] St Dev      19.0 [+ or -] 20.2[degrees]
Bone Graft Avg [+ or -] St Dev   25.1 [+ or -] 24.7[degrees]
P-value                                    0.2653

                                       Max
                                      Weight
                                      (lbs)

Augment Avg [+ or -] St Dev      7.7 [+ or -] 7.8
Bone Graft Avg [+ or -] St Dev   5.7 [+ or -] 7.5
P-value                               0.2783


----------

Please note: Illustration(s) are not available due to copyright restrictions.
COPYRIGHT 2015 J. Michael Ryan Publishing Co.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2015 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Jones, Richard B.; Wright, Thomas W.; Roche, Christopher P.
Publication:Bulletin of the NYU Hospital for Joint Diseases
Article Type:Report
Date:Oct 1, 2015
Words:5426
Previous Article:Reverse shoulder arthroplasty augments for glenoid wear: comparison of posterior augments to superior augments.
Next Article:Revision total shoulder arthroplasty without humeral component removal: a preliminary report on the role of a platform humeral component.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |