Bone grafting for glenoid deficiency in total shoulder replacement

Twenty-eight patients had glenoid bone grafting for segmental glenoid wear as a part of total shoulder arthroplasty. Nineteen of these patients had osteoarthritis and 5 had arthritis associated with shoulder instability. Follow-up evaluation averaged 5.3 years (range, 2 to 11 years). Autogenous humeral head grafts were used in 27 patients. In 25 patients, 3.5-mm cortical screws were used for fixation. Postoperatively, there was no or slight pain in 25 patients and moderate pain in 3 patients. Postoperative motion averaged 126° in abduction, 39° in external rotation, and T12 in internal rotation. According to Neerʹs result rating, 13 shoulders were excellent, 10 satisfactory, and 5 unsatisfactory (symptomatic glenoid loosening in 2, reoperation for instability in 2, and persistent pain in 1). Radiographically, 13 shoulders had no lucencies, 11 had incomplete lucencies, and 4 had complete lucencies. In 3 of these, the lucencies were at least 1.5 mm wide. These glenoids were considered radiographically loose; however, only 2 were symptomatic. When this technique is used to restore glenoid bone and joint alignment, clinical and radiographic results are similar to those for total shoulder arthroplasty overall. (J Shoulder Elbow Surg 2000;9:361-7.)