Article in Press
Expand allCollapse all

Abstract

INTRODUCTION

Glenoid bone loss presents a challenging dilemma, particularly in the setting of failed arthroplasty requiring conversion to a reverse total shoulder arthroplasty (rTSA). Biologic glenoid grafting is one of the current options for addressing this deformity. The aim of our systematic review was to examine the success and failure of biologic glenoid bone grafting to address vault deficiencies in the setting of shoulder arthroplasty conversion to rTSA.

METHODS

PUBMED was used to search for articles related to revision to reverse shoulder arthroplasty, bone grafting, and glenoid bone loss was performed. Twelve articles were included and fully reviewed. Inclusion criteria included glenoid bone grafting for conversion of failed arthroplasty and a minimum of 12 months follow-up. Exclusion criteria included grafting for primary rTSA, and re-revision for infection or humeral loosening. Failures were defined as failure of the graft to radiographically incorporate, symptomatic base plate loosening, and need for further surgical re-revision.

RESULTS

Two hundred patients were identified across the 12 articles. Seventy-three cases utilized autograft (43 structural, 31 non-structural cortico-cancellous grafts). One hundred twenty-one patients underwent allografting (81 structural, 40 non-structural). Six patients had hybrid grafting. Eighteen percent (36/200) of all cases demonstrated failure to radiographically incorporate. Thirteen percent (25/200) of all grafting cases required re-revision due to symptomatic failure (pain or functional deterioration). Femoral shaft demonstrated the highest failure rate at 88% (7/8). Overall, there was an 82% success rate of biological graft utilization.

CONCLUSION

Grafting for glenoid bone loss in the setting of conversion to rTSA has an 82% rate of success across autograft and allograft utilization. Grafting techniques, implant system utilized, glenosphere size used and baseplate fixation methodology may impact results. Further studies are needed to better define the success of autografting versus allografting in the setting of shoulder arthroplasty conversion to rTSA with glenoid bone loss.

Anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) are two of the most common surgical treatments for a variety of degenerative conditions of the shoulder1x1Antuna, S.A., Sperling, J.W., Cofield, R.H., and Rowland, C.M. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001; 10: 217–224

Abstract | Full Text | Full Text PDF | PubMed | Scopus (230)
| Google ScholarSee all References
, 2x2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (24)
| Google ScholarSee all References
, 3x3Fox, T.J., Foruria, A.M., Klika, B.J., Sperling, J.W., Schleck, C.D., and Cofield, R.H. Radiographic survival in total shoulder arthroplasty. J Shoulder Elbow Surg. 2013; 22: 1221–1227https://doi.org/10.1016/j.jse.2012.12.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (57)
| Google ScholarSee all References
, 4x4Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D., and Walch, G. Reverse Total Shoulder Arthroplasty: Survivorship Analysis of Eighty Replacements Followed for Five to Ten Years. J Bone Jt Surg. 2006; 88: 1742–1747https://doi.org/10.2106/JBJS.E.00851

Crossref | PubMed | Scopus (559)
| Google ScholarSee all References
. Although clinical improvement after both procedures has been well documented, complications can be devastating2x2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (24)
| Google ScholarSee all References
,8x8Kelly, J.D., Zhao, J.X., Hobgood, E.R., and Norris, T.R. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012; 21: 1516–1525https://doi.org/10.1016/j.jse.2011.11.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (100)
| Google ScholarSee all References
,11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
. The increasing number of shoulder arthroplasties portends a subsequent increase in the number of complications including infection, osteolysis, instability, fracture, loss of motion, humeral bone loss, glenoid bone loss, and continued pain. Revision arthroplasty to address these complications presents a new array of difficulties.

One particular challenge is the management of glenoid bone loss during revision of anatomic to reverse total shoulder arthroplasty. Complications of revision to rTSA in the setting of glenoid bone loss include scapular notching, glenoid baseplate loosening, component instability, persistent pain, reduced function, and potentially catastrophic failure1x1Antuna, S.A., Sperling, J.W., Cofield, R.H., and Rowland, C.M. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001; 10: 217–224

Abstract | Full Text | Full Text PDF | PubMed | Scopus (230)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
,15x15Ozgur, S.E., Sadeghpour, R., and Norris, T.R. Revision shoulder arthroplasty with a reverse shoulder prosthesis: Use of structural allograft for glenoid bone loss. Orthop. 2017; 46: 1055–1062https://doi.org/10.1007/s00132-017-3494-3

Crossref | Scopus (8)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
,19x19Walker, M., Willis, M.P., Brooks, J.P., Pupello, D., Mulieri, P.J., and Frankle, M.A. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21: 514–522https://doi.org/10.1016/j.jse.2011.03.006

Abstract | Full Text | Full Text PDF | PubMed | Scopus (118)
| Google ScholarSee all References
. Current options for addressing this deformity include eccentric reaming, biologic glenoid bone grafting, metallic glenoid augments and custom baseplates. There is a paucity of peer reviewed literature evaluating biologic glenoid bone grafting in the setting of revision to rTSA. The purpose of this study was to review the available literature and evaluate the success of different grafts and techniques.

Methods

Search Strategy

The present study was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA)9x9Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gotzsche, P.C., Ioannidis, J.P. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62: e1–e34https://doi.org/10.1016/j.jclinepi.2009.06.006

Abstract | Full Text | Full Text PDF | PubMed | Scopus (6636)
| Google ScholarSee all References
. A systematic review of the literature using a PUBMED search of articles related to revision to reverse shoulder arthroplasty, bone grafting, and glenoid bone loss was performed. Articles were identified and after abstract review, 21 papers were fully reviewed, resulting in 12 papers relevant to the topic.

Study Eligibility Criteria

Studies were selected on the basis of the following criteria: (1) study population: patients requiring bone grafting for conversion of failed arthroplasty; (2) minimum of 12 months follow-up; (3) studies written in English. Failures were defined as failure of the graft to radiographically incorporate, symptomatic base plate loosening, and need for further surgical revision.

Studies were excluded if: (1) bone grafting for primary rTSA; (2) re-revision for infection or aseptic humeral hardware loosening.

Quality assessment

The reliability of results depends on the extent to which potential sources of bias have been avoided. To adopt the same method to evaluate all selected studies, three reviewers independently applied the “assessing risk of bias” table to assess the risk of bias in each included study. The following biases were assessed: selection bias, performance bias, attrition bias, detection bias, reporting bias, and other bias. Disagreements were resolved through discussion between the reviewers

Statistical analysis

The compilation of this study was determined by documenting the methodological distinctions among several studies by analyzing the data extraction tables. In all cases, P values <0.05, were considered statistically significant.

Results

Two-hundred patients were identified to have met inclusion criteria across the 12 selected articles2x2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (24)
| Google ScholarSee all References
,5x5Ho, J.C., Thakar, O., Chan, W.W., Nicholson, T., Williams, G.R., and Namdari, S. Early radiographic failure of reverse total shoulder arthroplasty with structural bone graft for glenoid bone loss. J Shoulder Elbow Surg. 2020; 29: 550–560https://doi.org/10.1016/j.jse.2019.07.035

Abstract | Full Text | Full Text PDF | PubMed | Scopus (21)
| Google ScholarSee all References
, 6x6Iannotti, J.P. and Frangiamore, S.J. Fate of large structural allograft for treatment of severe uncontained glenoid bone deficiency. J Shoulder Elbow Surg. 2012; 21: 765–771https://doi.org/10.1016/j.jse.2011.08.069

Abstract | Full Text | Full Text PDF | PubMed | Scopus (55)
| Google ScholarSee all References
, 7x7Jones, R.B., Wright, T.W., and Zuckerman, J.D. Reverse total shoulder arthroplasty with structural bone grafting of large glenoid defects. J Shoulder Elbow Surg. 2016; 25: 1425–1432https://doi.org/10.1016/j.jse.2016.01.016

Abstract | Full Text | Full Text PDF | PubMed | Scopus (56)
| Google ScholarSee all References
, 8x8Kelly, J.D., Zhao, J.X., Hobgood, E.R., and Norris, T.R. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012; 21: 1516–1525https://doi.org/10.1016/j.jse.2011.11.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (100)
| Google ScholarSee all References
,10x10Lopiz, Y., García-Fernández, C., Arriaza, A., Rizo, B., Marcelo, H., and Marco, F. Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2017; 26: 1581–1588https://doi.org/10.1016/j.jse.2017.01.017

Abstract | Full Text | Full Text PDF | Scopus (25)
| Google ScholarSee all References
,11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
, 14x14Neyton, L., Boileau, P., Nové-Josserand, L., Edwards, T.B., and Walch, G. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007; 16: S71–S78https://doi.org/10.1016/j.jse.2006.02.002

Abstract | Full Text | Full Text PDF | PubMed | Scopus (120)
| Google ScholarSee all References
, 15x15Ozgur, S.E., Sadeghpour, R., and Norris, T.R. Revision shoulder arthroplasty with a reverse shoulder prosthesis: Use of structural allograft for glenoid bone loss. Orthop. 2017; 46: 1055–1062https://doi.org/10.1007/s00132-017-3494-3

Crossref | Scopus (8)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
,19x19Walker, M., Willis, M.P., Brooks, J.P., Pupello, D., Mulieri, P.J., and Frankle, M.A. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21: 514–522https://doi.org/10.1016/j.jse.2011.03.006

Abstract | Full Text | Full Text PDF | PubMed | Scopus (118)
| Google ScholarSee all References
. Seventy-three cases utilized autograft, including 43 structural grafts and 31 non-structural cortico-cancellous grafts. Structural autografts included tricortical iliac crest and proximal humerus. Non-structural cortico-cancellous grafts included iliac crest. One-hundred twenty one patients underwent allografting, including 81 structural and 40 non-structural. Structural allografts included tricortical iliac crest, humeral head, femoral head/neck, proximal humerus, and fibula. Six patients had hybrid autograft/allografting

Of the shoulders requiring grafting for glenoid bone loss, 18% (36/200) demonstrated failure to radiographically incorporate within the 2 year follow-up period. Twenty-five of 200 (13%) patients required revision due to instability caused by failure of components to incorporate or aseptic loosening after initial incorporation. The most common autograft utilized was tricortical iliac bone graft. Allografts commonly used were femoral neck and cortico-cancellous chips or putty. Femoral shaft allografts demonstrated the highest failure rate at 88% (7/8), primarily due to graft fracture. Other associated factors for failure seen amongst the articles included short stemmed base plates and non-locking screws for the baseplate5x5Ho, J.C., Thakar, O., Chan, W.W., Nicholson, T., Williams, G.R., and Namdari, S. Early radiographic failure of reverse total shoulder arthroplasty with structural bone graft for glenoid bone loss. J Shoulder Elbow Surg. 2020; 29: 550–560https://doi.org/10.1016/j.jse.2019.07.035

Abstract | Full Text | Full Text PDF | PubMed | Scopus (21)
| Google ScholarSee all References
,7x7Jones, R.B., Wright, T.W., and Zuckerman, J.D. Reverse total shoulder arthroplasty with structural bone grafting of large glenoid defects. J Shoulder Elbow Surg. 2016; 25: 1425–1432https://doi.org/10.1016/j.jse.2016.01.016

Abstract | Full Text | Full Text PDF | PubMed | Scopus (56)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
. Scapular notching did not show definitive association with failure. Overall, there was an 82% success rate of biological graft utilization.

Discussion

Glenoid bone loss is frequently encountered in glenohumeral osteoarthritis and may be seen in acute shoulder trauma2x2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (24)
| Google ScholarSee all References
,8x8Kelly, J.D., Zhao, J.X., Hobgood, E.R., and Norris, T.R. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012; 21: 1516–1525https://doi.org/10.1016/j.jse.2011.11.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (100)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
and may create challenges in primary glenohumeral arthroplasty. Treatment options include adjustments in prosthesis positioning, asymmetric glenoid reaming, glenoid bone grafting or augmented glenoid components.

When aTSA fails secondary to glenoid component loosening, the resulting bone loss is often substantial and may impact revision procedures. In cases with large glenoid bone defects, bone grafting may be required for component fixation and prosthetic stability. Currently, there is no consensus about the choice of bone graft for glenoid reconstruction.

Autograft

Structural grafting is usually indicated when less than 50% of the baseplate can be supported by native glenoid bone16x16Singh, J.A., Sperling, J.W., and Cofield, R.H. Revision surgery following total shoulder arthroplasty: Analysis of 2588 shoulders over three decades (1976 to 2008). J Bone Joint Surg Br. 2011; 93-B: 1513–1517https://doi.org/10.1302/0301-620X.93B11.26938

Crossref | Scopus (110)
| Google ScholarSee all References
. In the 12 studies reviewed, iliac crest bone autograft (ICBA) was the most common autograft used 2x2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (24)
| Google ScholarSee all References
,11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
,14x14Neyton, L., Boileau, P., Nové-Josserand, L., Edwards, T.B., and Walch, G. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007; 16: S71–S78https://doi.org/10.1016/j.jse.2006.02.002

Abstract | Full Text | Full Text PDF | PubMed | Scopus (120)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
. A piece of tricortical bone is harvested and burred to create a uniform shape with the remaining glenoid. Long peripheral screws are used to set the baseplate to ensure screws pass through the graft into the native glenoid vault. This type of bone graft allows for improved implant support and multiple points of fixation, allowing for greater stability. Limitations of harvesting bone graft depend on the patient’s bone quality.

Allograft

Allografts for glenoid bone loss can also be structural or nonstructural. Nonstructural allograft bone chips, demineralized bone matrix (DBM), and proprietary grafting were used in the studies reviewed11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
,19x19Walker, M., Willis, M.P., Brooks, J.P., Pupello, D., Mulieri, P.J., and Frankle, M.A. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21: 514–522https://doi.org/10.1016/j.jse.2011.03.006

Abstract | Full Text | Full Text PDF | PubMed | Scopus (118)
| Google ScholarSee all References
. The most common structural allografts used were tricortical iliac crest, femoral neck, proximal humerus, humeral head, tibia, and fibula5x5Ho, J.C., Thakar, O., Chan, W.W., Nicholson, T., Williams, G.R., and Namdari, S. Early radiographic failure of reverse total shoulder arthroplasty with structural bone graft for glenoid bone loss. J Shoulder Elbow Surg. 2020; 29: 550–560https://doi.org/10.1016/j.jse.2019.07.035

Abstract | Full Text | Full Text PDF | PubMed | Scopus (21)
| Google ScholarSee all References
, 6x6Iannotti, J.P. and Frangiamore, S.J. Fate of large structural allograft for treatment of severe uncontained glenoid bone deficiency. J Shoulder Elbow Surg. 2012; 21: 765–771https://doi.org/10.1016/j.jse.2011.08.069

Abstract | Full Text | Full Text PDF | PubMed | Scopus (55)
| Google ScholarSee all References
, 7x7Jones, R.B., Wright, T.W., and Zuckerman, J.D. Reverse total shoulder arthroplasty with structural bone grafting of large glenoid defects. J Shoulder Elbow Surg. 2016; 25: 1425–1432https://doi.org/10.1016/j.jse.2016.01.016

Abstract | Full Text | Full Text PDF | PubMed | Scopus (56)
| Google ScholarSee all References
, 8x8Kelly, J.D., Zhao, J.X., Hobgood, E.R., and Norris, T.R. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012; 21: 1516–1525https://doi.org/10.1016/j.jse.2011.11.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (100)
| Google ScholarSee all References
,10x10Lopiz, Y., García-Fernández, C., Arriaza, A., Rizo, B., Marcelo, H., and Marco, F. Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2017; 26: 1581–1588https://doi.org/10.1016/j.jse.2017.01.017

Abstract | Full Text | Full Text PDF | Scopus (25)
| Google ScholarSee all References
,15x15Ozgur, S.E., Sadeghpour, R., and Norris, T.R. Revision shoulder arthroplasty with a reverse shoulder prosthesis: Use of structural allograft for glenoid bone loss. Orthop. 2017; 46: 1055–1062https://doi.org/10.1007/s00132-017-3494-3

Crossref | Scopus (8)
| Google ScholarSee all References
,19x19Walker, M., Willis, M.P., Brooks, J.P., Pupello, D., Mulieri, P.J., and Frankle, M.A. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21: 514–522https://doi.org/10.1016/j.jse.2011.03.006

Abstract | Full Text | Full Text PDF | PubMed | Scopus (118)
| Google ScholarSee all References
.

The purpose of this study was to analyze the limited data that is available currently to determine what type of grafting produces more successful outcomes in the setting of revision anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty. In studies directly comparing iliac crest bone autografts (ICBA) to nonstructural bone allograft, ICBA had no increased risk of component failure, radiographic or clinical complications, or worse clinical outcomes12x12Malik, S.S., Elashry, S., Jordan, R.W., Choudhary, S., and Kalogrianitis, S. Is there a difference in outcome of arthroscopic iliac crest autograft and allograft in recurrent anterior shoulder instability?. Eur J Orthop Surg Traumatol. 2020; 30: 1453–1461https://doi.org/10.1007/s00590-020-02722-2

Crossref | Scopus (4)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
. Scapular notching in patients with ICBA occurred in 8-54%11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
. Resorption of the graft ranged from 21-40%5x5Ho, J.C., Thakar, O., Chan, W.W., Nicholson, T., Williams, G.R., and Namdari, S. Early radiographic failure of reverse total shoulder arthroplasty with structural bone graft for glenoid bone loss. J Shoulder Elbow Surg. 2020; 29: 550–560https://doi.org/10.1016/j.jse.2019.07.035

Abstract | Full Text | Full Text PDF | PubMed | Scopus (21)
| Google ScholarSee all References
,11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
. Although there was some of baseplates shifting in both groups, all were clinically stable at 1 and 2 years postoperatively. Overall complications seen with ICBA were approximately 17%2x2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (24)
| Google ScholarSee all References
,7x7Jones, R.B., Wright, T.W., and Zuckerman, J.D. Reverse total shoulder arthroplasty with structural bone grafting of large glenoid defects. J Shoulder Elbow Surg. 2016; 25: 1425–1432https://doi.org/10.1016/j.jse.2016.01.016

Abstract | Full Text | Full Text PDF | PubMed | Scopus (56)
| Google ScholarSee all References
,11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
,14x14Neyton, L., Boileau, P., Nové-Josserand, L., Edwards, T.B., and Walch, G. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007; 16: S71–S78https://doi.org/10.1016/j.jse.2006.02.002

Abstract | Full Text | Full Text PDF | PubMed | Scopus (120)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
. Neyton et al had a group of 6 patients undergoing ICBA during revision procedure. Although all 6 patients demonstrated incorporation of graft at the 2 year follow-up, the sample size is small and the results may not be extrapolated to a larger group 14x14Neyton, L., Boileau, P., Nové-Josserand, L., Edwards, T.B., and Walch, G. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007; 16: S71–S78https://doi.org/10.1016/j.jse.2006.02.002

Abstract | Full Text | Full Text PDF | PubMed | Scopus (120)
| Google ScholarSee all References
.

Three studies reported on revision rTSA and allograft glenoid reconstruction8x8Kelly, J.D., Zhao, J.X., Hobgood, E.R., and Norris, T.R. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012; 21: 1516–1525https://doi.org/10.1016/j.jse.2011.11.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (100)
| Google ScholarSee all References
,11x11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026

Abstract | Full Text | Full Text PDF | Scopus (15)
| Google ScholarSee all References
,15x15Ozgur, S.E., Sadeghpour, R., and Norris, T.R. Revision shoulder arthroplasty with a reverse shoulder prosthesis: Use of structural allograft for glenoid bone loss. Orthop. 2017; 46: 1055–1062https://doi.org/10.1007/s00132-017-3494-3

Crossref | Scopus (8)
| Google ScholarSee all References
. Ozgur et al studied 20 patients undergoing 24 revision with various structural allografts. Patients received an allograft when they had glenoid bone loss of Walch classification18x18Walch, G., Boulahia, A., Boileau, P., and Kempf, J.F. Primary glenohumeral osteoarthritis: clinical and radiographic classification. The Aequalis Group. Acta Orthop Belg. 1998; 64: 46–52

PubMed
| Google ScholarSee all References
grade IIB or higher or needed the increased offset for stability. Nineteen patients (79.2%) were femoral shaft (8) and femoral neck (11). Fourteen (58.3%) of the grafts failed to incorporate, leading to overall surgical failure and need for further surgical intervention. They concluded that in patients with substantial glenoid bone loss, femoral neck allografts are option, but use of femoral shaft allografts is not recommended (12.5% incorporation rate). Walker et al reported rTSA with iliac crest allograft use19x19Walker, M., Willis, M.P., Brooks, J.P., Pupello, D., Mulieri, P.J., and Frankle, M.A. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21: 514–522https://doi.org/10.1016/j.jse.2011.03.006

Abstract | Full Text | Full Text PDF | PubMed | Scopus (118)
| Google ScholarSee all References
. Of the 15 patients requiring bone grafting at the time of revision, only 2 reported unsatisfactory scores with pain and function (9%). One of which had graft incorporation without resorption and one had no radiographic component failure. The overall complication rate was 22.7%, consistent with results seen with autograft13x13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (138)
| Google ScholarSee all References
,17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
. In the 30 revision to reverse total shoulder arthroplasties reported by Kelly et al, 12 patients required iliac crest allograft in the setting of revision8x8Kelly, J.D., Zhao, J.X., Hobgood, E.R., and Norris, T.R. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012; 21: 1516–1525https://doi.org/10.1016/j.jse.2011.11.021

Abstract | Full Text | Full Text PDF | PubMed | Scopus (100)
| Google ScholarSee all References
. When comparing those who received bone allograft, there were no differences in outcomes amongst patients, except for the ASES pain score, which was higher in the ICBA group. Only 1 allograft surgery failed, but the overall complication rate was higher due infection and intraoperative fracture.

When glenoid bone loss is less than 50%, nonstructural bone grafting may be considered. Nine out of 11 patients requiring bone grafting in Bitzer et al used non-structural corticocancellous bone chips as grafts2x2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034

Abstract | Full Text | Full Text PDF | PubMed | Scopus (24)
| Google ScholarSee all References
. Fourteen percent of nonstructural bone grafting led to aseptic glenoid baseplate loosening. The high rate of loosening may be attributed to the lack of fixation in morselized bone. Wager et al had a variety of patients using both structural and nonstructural grafting.17x17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732

Crossref | PubMed | Scopus (70)
| Google ScholarSee all References
One of 5 structural autografts showed severe glenoid loosening at follow-up and poor ASES scores. Eight of the 35 nonstructural autografts had glenoid loosening and required further surgical intervention. Like Bitzer, it was thought that majority of glenoid loosening in nonstructural autografts was sure to poor fixation and lack of component support.

Our study had certain limitations. Many of the papers reviewed that looked at both autograft and allograft failed to clarify which type of graft led to the failures reported. Multiple grafting surgical techniques and baseplate fixation methods were also used despite commonality of graft selection. There was also variability of implant design (Grammont vs. Non-Grammont), as well as glenosphere size in the reverse total shoulder arthroplasties. This systematic review did not address the option for metal augments as a solution for glenoid deficient conversion arthroplasties. Lastly, none of the papers specifically looked at autografting vs. allografting in the setting of revising anatomic total shoulder arthroplasties to reverse total shoulder arthroplasties.

Conclusion

In conclusion, glenoid bone grafting may be required in revision of aTSA to rTSA. There is no clear difference between failure rates of autograft vs allograft to address these defects. Nonstructural grafting may be effective for smaller defects, while larger defects may require structural grafts. To be successful, both autografts and allografts must incorporate and not resorb. However, reported results following these procedures are extremely variable with incorporation rates and patient outcomes. Further investigation into specifically using biologic bone graft for the conversion of anatomic to rTSA in the setting of glenoid bone loss needs to be completed to definitively conclude which type of grafting may lead to the optimal outcome.

Table 1
AuthorShoulder Revisions (N)AutograftAllograftHybrid
Bitzer et al.119 Nonstructural corticocancellous

2 Structural

2 Tricortical iliac crest
00
Ho et al.707 Structural

4 Tricortical iliac crest

1 Femoral head

1 Humeral head

1 Fibular strut
0
Iannotti et al.404 Structural

4 Femoral head
0
Jones et al.91 Structural

1 Tricortical iliac crest
8 Structural

8 Femoral head
0
Kelly et al.12012 Structural

12 Tricortical iliac crest
0
Lopiz et al.13013 Structural

11 Tibial plateau

2 Proximal femur
0
Mahylis et al.3015 Structural

15 Tricortical iliac crest
15 Nonstructural0
Melis et al.295 Nonstructural corticocancellous

21 Structural

21 Tricortical iliac crest
3 Nonstructural0
Neyton et al.66 Structural

6 Tricortical iliac crest
00
Ozgur et al.24024 Structural

11 Femoral neck/head

8 Femoral shaft

5 Proximal humerus
0
Wagner et al.*4014 Structural/Nonstructural

Tricortical iliac crest
20 Structural/Nonstructural

Humerus

CanPac

DBX
6
Walker et al.15010 Structural

10 Femoral head

5 Nonstructural
0
View Table in HTML

*Did not specify how many of structural vs. nonstructural grafts were used in the autograft vs. allograft groups

References

  1. 1Antuna, S.A., Sperling, J.W., Cofield, R.H., and Rowland, C.M. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001; 10: 217–224
  2. 2Bitzer, A., Rojas, J., Patten, I.S., Joseph, J., and McFarland, E.G. Incidence and risk factors for aseptic baseplate loosening of reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2018; 27: 2145–2152https://doi.org/10.1016/j.jse.2018.05.034
  3. 3Fox, T.J., Foruria, A.M., Klika, B.J., Sperling, J.W., Schleck, C.D., and Cofield, R.H. Radiographic survival in total shoulder arthroplasty. J Shoulder Elbow Surg. 2013; 22: 1221–1227https://doi.org/10.1016/j.jse.2012.12.034
  4. 4Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D., and Walch, G. Reverse Total Shoulder Arthroplasty: Survivorship Analysis of Eighty Replacements Followed for Five to Ten Years. J Bone Jt Surg. 2006; 88: 1742–1747https://doi.org/10.2106/JBJS.E.00851
  5. 5Ho, J.C., Thakar, O., Chan, W.W., Nicholson, T., Williams, G.R., and Namdari, S. Early radiographic failure of reverse total shoulder arthroplasty with structural bone graft for glenoid bone loss. J Shoulder Elbow Surg. 2020; 29: 550–560https://doi.org/10.1016/j.jse.2019.07.035
  6. 6Iannotti, J.P. and Frangiamore, S.J. Fate of large structural allograft for treatment of severe uncontained glenoid bone deficiency. J Shoulder Elbow Surg. 2012; 21: 765–771https://doi.org/10.1016/j.jse.2011.08.069
  7. 7Jones, R.B., Wright, T.W., and Zuckerman, J.D. Reverse total shoulder arthroplasty with structural bone grafting of large glenoid defects. J Shoulder Elbow Surg. 2016; 25: 1425–1432https://doi.org/10.1016/j.jse.2016.01.016
  8. 8Kelly, J.D., Zhao, J.X., Hobgood, E.R., and Norris, T.R. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elbow Surg. 2012; 21: 1516–1525https://doi.org/10.1016/j.jse.2011.11.021
  9. 9Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gotzsche, P.C., Ioannidis, J.P. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62: e1–e34https://doi.org/10.1016/j.jclinepi.2009.06.006
  10. 10Lopiz, Y., García-Fernández, C., Arriaza, A., Rizo, B., Marcelo, H., and Marco, F. Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2017; 26: 1581–1588https://doi.org/10.1016/j.jse.2017.01.017
  11. 11Mahylis, J.M., Puzzitiello, R.N., Ho, J.C., Amini, M.H., Iannotti, J.P., and Ricchetti, E.T. Comparison of radiographic and clinical outcomes of revision reverse total shoulder arthroplasty with structural versus nonstructural bone graft. J Shoulder Elbow Surg. 2019; 28: e1–e9https://doi.org/10.1016/j.jse.2018.06.026
  12. 12Malik, S.S., Elashry, S., Jordan, R.W., Choudhary, S., and Kalogrianitis, S. Is there a difference in outcome of arthroscopic iliac crest autograft and allograft in recurrent anterior shoulder instability?. Eur J Orthop Surg Traumatol. 2020; 30: 1453–1461https://doi.org/10.1007/s00590-020-02722-2
  13. 13Melis, B., Bonnevialle, N., Neyton, L., Favard, L., Walch, G., and Boileau, P. Glenoid loosening and failure in anatomical total shoulder arthroplasty: is revision with a reverse shoulder arthroplasty a reliable option?. J Shoulder Elbow Surg. 2012; 21: 342–349https://doi.org/10.1016/j.jse.2011.05.021
  14. 14Neyton, L., Boileau, P., Nové-Josserand, L., Edwards, T.B., and Walch, G. Glenoid bone grafting with a reverse design prosthesis. J Shoulder Elbow Surg. 2007; 16: S71–S78https://doi.org/10.1016/j.jse.2006.02.002
  15. 15Ozgur, S.E., Sadeghpour, R., and Norris, T.R. Revision shoulder arthroplasty with a reverse shoulder prosthesis: Use of structural allograft for glenoid bone loss. Orthop. 2017; 46: 1055–1062https://doi.org/10.1007/s00132-017-3494-3
  16. 16Singh, J.A., Sperling, J.W., and Cofield, R.H. Revision surgery following total shoulder arthroplasty: Analysis of 2588 shoulders over three decades (1976 to 2008). J Bone Joint Surg Br. 2011; 93-B: 1513–1517https://doi.org/10.1302/0301-620X.93B11.26938
  17. 17Wagner, E., Houdek, M.T., Griffith, T., Elhassan, B.T., Sanchez-Sotelo, J., Sperling, J.W. et al. Glenoid Bone-Grafting in Revision to a Reverse Total Shoulder Arthroplasty. J Bone Jt Surg. 2015; 97: 1653–1660https://doi.org/10.2106/JBJS.N.00732
  18. 18Walch, G., Boulahia, A., Boileau, P., and Kempf, J.F. Primary glenohumeral osteoarthritis: clinical and radiographic classification. The Aequalis Group. Acta Orthop Belg. 1998; 64: 46–52
  19. 19Walker, M., Willis, M.P., Brooks, J.P., Pupello, D., Mulieri, P.J., and Frankle, M.A. The use of the reverse shoulder arthroplasty for treatment of failed total shoulder arthroplasty. J Shoulder Elbow Surg. 2012; 21: 514–522https://doi.org/10.1016/j.jse.2011.03.006

Institutional review board approval was not required for this review article.

Disclaimers:

Funding: No funding was disclosed by the authors.

Conflicts of interest: The authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Level of Evidence: Level I Systematic Review

 

Linked Articles

Unknown widget #d2170c4d-a9cf-482f-ac17-ef77d57a1866

of type linkedContentList

Related Articles

Unknown widget #c2ffda61-8426-42f7-926b-03d7330eede2

of type relatedArticleListWidget