The Journal of Bone and Joint Surgery, Vol 70, Issue 8 1154-1162, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Glenoid bone-grafting in total shoulder arthroplasty
CS Neer and DS Morrison
Columbia University College of Physicians and Surgeons, New York City, N.Y. 10032.
Abnormal glenoid architecture resulting from loss of bone usually is listed
among the contraindications to total shoulder arthroplasty using an
unconstrained prosthesis. However, in a series of 463 consecutive
replacement procedures that were performed between 1973 and 1985, in only
two patients did the lack of bone make the implantation of a glenoid
component impossible. Of the remaining sixty-five shoulders that had an
abnormal glenoid, twenty were successfully treated with a large, internally
fixed bone graft or grafts and forty-five, with smaller bone grafts that
were not internally fixed. Nineteen of the twenty shoulders that had a
large graft or grafts were followed for two years or more (average, 4.4
years). The clinical results were judged to be excellent in sixteen and
satisfactory in one, and the desired limited goals were obtained in two.
Two fixation screws broke and one screw was worn by contact with the
humeral component. None of the glenoid components clinically loosened or
migrated, and no patient has needed further surgical treatment. Although
bone-grafting was necessary in only twenty (4.3 per cent) of the 463
replacement procedures, this procedure provided sufficient osseous support
to allow implantation of a component in a severely damaged glenoid.
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