Revision Arthroplasty with a Reverse shoulder- Allograft Composite
 

When revision shoulder arthroplasty is required, proximal humeral bone loss is a potential variable that necessitates careful preoperative planning. Although bone loss is typically noted preoperatively---a hemiarthroplasty may require revision to a reverse shoulder if fractured tuberosities fail to heal, for example, it may be unanticipated--following difficult removal of a well fixed stem.

In the former situation, Dr Mark Frankle has shown quite favorable outcomes using allograft proximal humerus to reconstruct the missing proximal humerus. This may both improve stability, by further tensioning the deltoid, and improve survivability of the new stem by diminishing the impact of loads purely on the new cement mantle.

As much as possible, the latter cause can be prevented by performing a controlled osteotomy along the bicipital groove as a means of loosening a well fixed stem--thus obviating the use of osteotomes proximally in order to preserve bone.

This past week I encountered the need for such a construct, and in fact anticipated the need based on the degree of proximal hone loss on the preoperative x-ray. Notwithstanding the use of the DJO reverse shoulder, which has a laterlized center of rotation, stability was not optimal until I added the allograft construct to the equation. The addition of the bone further tensioned the deltoid---and in a nutshell, reconstructed the anatomy to a near normal construct.

Not until I visited Dr Frankle did I appreciate the value of this approach. Indeed, the use of a constrained design like the reverse shoulder with cup build ups and glenosheres of different sizes usually "compensates" for missing bone and rotator cuff. But--in the occasional case for which stability cannot be achieved with thicker liners or larger glenosheres, this is a useful technique.

I have attached a preoperative x-ray, an illustration of the construct, and an intraoperative picture of the construct . If you would like to read Dr Frankle's paper, visit this link and scroll down:
http://www.rearmyourself.com/article...al%20Bone-Loss

The attached x-ray reveals the 1st postoperative view of the Allograft-Reverse construct. His pain is much improved already. The addition of the allograft helped provide superb stability. Click on this link for the article that Dr Frankle published regarding this technique:

http://www.rearmyourself.com/assets/...0Composite.pdf

This link provides a pre-revision video as well as an early post-revision video. The revision reverse was unstable until the allograft cnstruct was placed. For more information about this type of allograft-prosthesis construct, I have attached a PDF of the article at this link, as well.


http://www.rearmyourself.com/article...al%20Bone-Loss