Reverse shoulder arthroplasty for glenoid deformities: a retrospective cohort study

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Abstract

BACKGROUND: Reverse shoulder arthroplasty is increasingly becoming the standard surgical treatment for shoulder joint conditions. To our knowledge, in cases of glenoid deformities, lateralization of the scapular component of the shoulder prosthesis plays an important role. Several methods are used to achieve the scapular component lateralization, one of which is the use of a patient-specific metallic augment. We present the treatment outcomes of patients who underwent standard reverse shoulder arthroplasty without glenoid modeling versus those treated with a patient-specific metallic augment.

AIM: The work aimed to evaluate the outcomes of reverse shoulder arthroplasty performed using the standard technique and with a patient-specific metallic augment in patients with glenoid deformities.

METHODS: It was a single-center retrospective cohort study. Between 2019 and 2024, 62 patients with scapulohumeral osteoarthritis and associated glenoid deformities were treated in the Department of Traumatology and Orthopedics No. 1 of the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics (Moscow). A total of 31 patients underwent standard reverse shoulder arthroplasty, whereas the remaining 31 received implantation of a patient-specific metallic augment manufactured using additive technologies. Demographic and radiographic data, surgical technique, operative time, blood loss, and complications were recorded. Patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Functional outcomes were assessed using the ASES, DASH, UCLA, Constant, and VAS scores.

RESULTS: Of the 62 patients, 19 (30.64%) were men and 43 (69.36%) were women. Glenoid deformities were classified according to Walch as B1 in 31, B2 in 19, and B3 in 12 patients. The abduction angle was 120.6 ± 6.9° at the first postoperative assessment and 173.2 ± 6.8° at the final follow-up, compared with 83.4 ± 12.8° preoperatively (p < 0.05). In the patient-specific metallic augment group, compared with the control group, postoperative abduction, flexion, and external rotation improved, and the time to achieve full range of motion of the shoulder joint was reduced.

CONCLUSION: Both techniques resulted in comparable improvements in functional outcomes. However, the use of a patient-specific augment was associated with a higher frequency of achieving full shoulder joint range of motion, supporting the need for further evaluation of this technique.

About the authors

Ivan N. Marychev

Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: dr.ivan.marychev@mail.ru
ORCID iD: 0000-0002-5268-4972
SPIN-code: 9151-7883
Russian Federation, Moscow

Yago G. Gudushauri

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: gogich71@mail.ru
ORCID iD: 0009-0002-1584-1999

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow

Mikhail B. Tsykunov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: rehcito@mail.ru
ORCID iD: 0000-0002-0994-8602
SPIN-code: 8298-8338

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow

Evgeniy Yu. Fedotov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: fedotovej@mail.ru
ORCID iD: 0009-0000-1965-4264

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Vyacheslav V. Konovalov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: slava2801@yandex.ru
ORCID iD: 0000-0002-8954-9192
SPIN-code: 9552-2408

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Alexander D. Lamasov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: lamasovsasha@gmail.com
ORCID iD: 0009-0008-3669-3167
Russian Federation, Moscow

Sergey S. Stoyukhin

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: Sergey.stoyukhin@gmail.com
ORCID iD: 0009-0009-8511-3613

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Ivan A. Chugreev

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: chugreevivan@gmail.com
ORCID iD: 0000-0002-2752-9620
SPIN-code: 4745-3836
Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Modified Walch classification of glenoid defects in primary glenohumeral arthritis (author’s illustration). Type A, central glenoid erosion (A1, minimal erosion, A2, more significant bone loss); Type B, posterior subluxation of the humeral head (B1, joint space narrowing, subchondral sclerosis and osteophytes; B2, biconcave glenoid due to posterior rim erosion; B3, posterior rim erosion with pathological retroversion); Type C, pathological retroversion of the scapular articular surface; Type D, anterior rim erosion of the glenoid with anterior subluxation of the humeral head.

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3. Fig. 2. Study design.

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4. Fig. 3. Modeling of glenoid deformity and determination of the correct implantation axis of the metaglene (published with the permission of Endoprint).

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5. Fig. 4. Prototype of the patient-specific augment and guide in the form of a 3D model (published with the permission of Endoprint).

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6. Fig. 5. Patient-specific titanium augment and guide.

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7. Fig. 6. Range of motion of patient K. before surgery.

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8. Fig. 7. Computed tomography of the shoulder of patient K.

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9. Fig. 8. Modeling of glenoid deformity and determination of the correct implantation axis of the metaglene in patient K. (published with the permission of Endoprint).

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10. Fig. 9. Prototype of the patient-specific augment and guide in the form of a 3D model for patient K. (published with the permission of Endoprint).

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11. Fig. 10. Patient-specific titanium augment and guide for patient K.

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12. Fig. 11. Deformed glenoid of patient K.

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13. Fig. 12. Patient-specific augment and surgical stages in patient K.

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14. Fig. 13. Postoperative radiograph of patient K.

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15. Fig. 14. Radiographic follow-up 1 year after surgery.

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16. Fig. 15. Range of motion in the right shoulder joint of patient K. 1 year after surgery.

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