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Patient-Specific Implants in Severe Glenoid Bone Loss

February 8, 2018 | Surgery
Ivan De Martino, MD ; David M. Dines, MD ; Russell F. Warren, MD ; Edward V. Craig, MD, MPH ; Lawrence V. Gulotta, MD
Author and Disclosure Information

Authors’ Disclosure Statement: Dr. De Martino reports that he is a consultant to Lima Corporate. Dr. Dines and Dr. Craig report that they receive royalties from Zimmer Biomet for the development of the product (Comprehensive Shoulder VRS) discussed in this article. Dr. Gulotta reports that he is a consultant to Zimmer Biomet. Dr. Warren reports no actual or potential conflict of interest in relation to this article.

Dr. De Martino is a Clinical Fellow, Sports Medicine and Shoulder Service Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. Dr. Dines is an Attending Orthopaedic Surgeon, Hospital for Special Surgery, Sports Medicine and Shoulder Service Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, Professor, Weill Cornell Medical College, as well as Chairman and Professor of Orthopedic Surgery, Albert Einstein College of Medicine at LIJ, Bronx, New York. Dr. Warren is Professor of Orthopedic Surgery, Weill Cornell Medical College, and Attending Orthopedic Surgeon, Hospital for Special Surgery, Sports Medicine and Shoulder Service Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. Dr. Craig is Chief Executive Officer, TRIA Orthopaedic Center Professor of Orthopaedic Surgery, University of Minnesota TRIA Orthopaedic Center, Bloomington, Minnesota. Dr. Gulotta is an Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery, and Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College, Sports Medicine and Shoulder Service Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.

Address correspondence to: Lawrence V. Gulotta, MD, Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 (tel, 646-797-8735; fax, 646-797-8726; email, gulottal@hss.edu).

Ivan De Martino, MD David M. Dines, MD Russell F. Warren, MD Edward V. Craig, MD, MPH Lawrence V. Gulotta, MD . Patient-Specific Implants in Severe Glenoid Bone Loss. Am J Orthop. February 8, 2018

TAKE-HOME POINTS

  • With the increasing number of arthroplasties performed, and the expanding indication for shoulder arthroplasty, the number of revision shoulder arthroplasties is also increasing.
  • Complex glenoid bone defects are sometimes encountered in revision shoulder arthroplasties.
  • Glenoid reconstructions with bone graft have reported encouraging short- to mid-term results, but the high number of complications is a concern.
  • Using the CAD/CAM technology patient-specific glenoid components have been created to reconstruct the glenoid vault in cases of severe glenoid bone loss.
  • Short-term clinical and radiographic results of patient-specific glenoid components are encouraging, however longer-term follow-up are needed to confirm the efficacy of this type of reconstruction.

Total shoulder arthroplasty (TSA) is an effective operation for providing pain relief and improving function in patients with end-stage degenerative shoulder disease that is nonresponsive to nonoperative treatments.1-4 With the increasing number of arthroplasties performed, and the expanding indication for shoulder arthroplasty, the number of revision shoulder arthroplasties is also increasing.5-14 Complex glenoid bone deformities present the treating surgeon with a complex reconstructive challenge. Although glenoid bone loss can be seen in the primary setting (degenerative, congenital, and post-traumatic), severe glenoid bone loss is encountered mostly in revision TSAs.

Historically, patients with severe glenoid bone loss were treated with a hemiarthroplasty.15-17 However, due to inferior outcomes associated with the use of shoulder hemiarthroplasties compared with TSA in these cases,18-20 various techniques were developed with the aim of realigning the glenoid axis and securing the implants into the deficient glenoid vault.21-25 Options have included eccentric reaming, glenoid reconstruction with bone autografts and allografts, and more recently augmented components and patient-specific implants. Studies with eccentric reaming and reconstruction with bone graft during complex shoulder arthroplasty have reported encouraging short- to mid-term results, but the clinical and radiographic outcomes remain inconsistent, and the high number of complications is a concern.25-28

Complications with these techniques include component loosening, graft resorption, nonunion, failure of graft incorporation, infection, and instability.25-28

Computer-aided design and computer-aided manufacturing (CAD/CAM) of patient-specific implants have been used successfully by hip arthroplasty surgeons to deal with complex acetabular reconstructions in the setting of severe bone loss. More recently, the same technology has been used to reconstruct the glenoid vault in cases of severe glenoid bone loss.

In this article, we describe a patient-specific glenoid implant, its indication, and both technical aspects and the surgical technique, based on the authors’ experience as well as a review of the current literature on custom glenoid implants.

Continue to: PATIENT-SPECIFIC GLENOID COMPONENT

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