Glenoid Structural Bone Grafting in Reverse Total Shoulder Arthroplasty: Clinical and Radiographic Outcomes.

INTRODUCTION: Current options for reconstruction of large glenoid defects in reverse total shoulder arthroplasty (RTSA) include structural bone grafting, utilization of augmented components, or 3D printed custom implants. Given the paucity in the literature on structural bone grafts in RTSA, this study reflects our experience on clinical and radiographic outcomes of structural bone grafts utilized for glenoid defects in RTSA. METHODS: We identified 33 consecutive patients who underwent RTSA utilizing structural bone grafts for glenoid bone loss between 2008 and 2019. Twenty-six patients with mean clinical follow-up of 4.4 ± 3.9 years and mean radiographic follow-up of 2.7 ± 3.2 years were included. Patient demographic data, peri-operative functional outcomes, radiographic outcomes, complications, and re-operation rates were determined. RESULTS: Between 2008 and 2019, 26 RTSAs were performed utilizing structural autograft or allograft for glenoid defects. There were 20 females (77%) and 6 males (23%), with mean presenting age of 68 years (range 41-86), mean BMI of 29 (range 21-44) and mean Charlson Comorbidity Index of 3 (range 0-8). There were 19 cases of central glenoid defects, and 7 were combined central and peripheral defects. Structural grafts included humeral head autograft (7), proximal humerus autograft (7), iliac crest autograft (7), distal clavicle autograft (2), and femoral head allograft (3). All eighteen revision RTSA cases had simultaneous humeral-sided revision. There was significant postoperative improvement in ASES scores (27.0 ± 12.6 preop vs. 59.8 ± 24.1 postop; p<0.001) and VAS scores (8.1 ± 3.6 preop vs. 3.0 ± 3.2 postop; p<0.001). Range of motion improved significantly for active forward elevation (63 ± 36º preop vs. 104 ± 36º postop; p<0.001) and external rotation (21 ± 20º preop vs. 32 ± 23º postop, p=0.036). Eighty-eight percent (23/26) of cases had successful reconstruction of the glenoid, defined as no visible radiolucent lines nor glenoid component migration at final follow-up. Re-operation rate was 19% (5/26) Postoperative complications included 2 cases of acromial stress fractures that were treated non-operatively, for a total complication rate (including re-operation) of 27% (7/26 cases). CONCLUSIONS: The use of structural bone autografts and allografts in RTSA was associated with improved outcome scores and range of motion. A reoperation rate of 19% and total complication rate of 27% were reported for these challenging cases. However, 86% of these complications were not related to structural glenoid reconstruction failure. Structural grafts are a reasonable option for glenoid reconstruction in RTSA cases with glenoid bone loss.

Safety and Efficacy of Intraoperative Computer-Navigated Versus Non-Navigated Shoulder Arthroplasty at a Tertiary Referral.

Emerging technologies in shoulder arthroplasty, such as 3-dimensional planning software and real-time intraoperative navigation, are now available for surgeons to perform more accurate placement of the glenoid component without malposition or perforation. Using these tools, the surgeon can visualize the version, inclination, and containment of the implant and determine whether augmented components would be necessary. This review provides an updated investigation of the present literature to elucidate the role of computer navigation in modern shoulder arthroplasty.

Corticosteroid response and supporting cell antibody in autoimmune hearing loss.

OBJECTIVE: To determine whether antibodies to supporting cells are associated with response to corticosteroids in patients with autoimmune sensorineural hearing loss. DESIGN: Prospective analysis of antibody to inner-ear antigens. SETTING: Collaborating otology practices in Pennsylvania, Michigan, and Indiana. PATIENTS: Sixty-three patients with rapidly progressive unilateral or bilateral sensorineural hearing loss of unknown cause suggestive of autoimmune sensorineural hearing loss. INTERVENTIONS: Pretreatment audiometry, serum analysis by Western blot (WB) and immunofluorescence (IF) tests, corticosteroid therapy, and follow-up audiometry. MAIN OUTCOME MEASURES: Antibody reactivity and audiogram changes were analyzed for association with response to treatment. RESULTS: More than half of the patients (37/63) had antibodies to both a 68- to 72-kDa protein and to inner-ear supporting cells, 16 patients had positive results on one assay only, and 10 had negative results on both. Twenty-eight patients improved and 35 did not. The WB findings did not correlate with response. Of the WB-positive patients, 49% (21/43) improved, as did 35% (7/20) of the WB-negative patients (P = .30). In contrast, 53% (25/47) of IF-positive patients improved, compared with only 19% (3/16) in the IF-negative group (P = .02). Of those who improved, 89% (25/28) were IF positive. CONCLUSIONS: Antibody to an inner-ear supporting cell antigen was significantly associated with hearing improvement after corticosteroid therapy (relative rate, 2.8). Patients with IF-positive serum are nearly 3 times more likely to experience improved hearing with corticosteroid treatment than those who are IF negative. Antibodies to inner-ear supporting cell antigen may have value in diagnosis and treatment of patients with autoimmune sensorineural hearing loss.