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TSR: Bone Grafting for the Glenoid Component

           - indicated for glenoid insufficiency w/ insufficient bone stock for appropriate component fixation:
                   - cortical penetration of component keel into the glenoid neck;
                   - incomplete peripheral contact of the glenoid component flange;
                   - greater than 20 deg of retroversion or anteversion of the glenoid component;
                           - alteration of glenoid version may affect glenoid component fixation in these patients;
           - in the report by Hill JM, et al, the authors evaluated the long-term results associated with the use of  bone-grafting for restoration of glenoid volume and version at the time of total shoulder arthroplasty;
                   - 21 shoulders received an internally fixed, corticocancellous bone graft for the restoration of peripheral glenoid bone stock at time of TSR between 1980 and 1989;
                   - grafting was indicated when glenoid bone stock was insufficient to maintain adequate version or fixation of the prosthesis;
                   - 17 shoulders were available for follow-up; the average duration of follow-up for the thirteen shoulders that did not have prosthetic failure within the first two years was seventy months;
                   - TSR was performed because of osteoarthritis in five shoulders, chronic anterior fracture-dislocation in five, capsulorrhaphy arthropathy in three, inflammatory arthritis in two, recurrent dislocation in one, and failure of a previous arthroplasty in one;
                   - all patients had some form of anterior or posterior instability preoperatively;
                   - there were five anterior and twelve posterior glenoid defects.
                   - bone from the resected humeral head was used for grafting in fifteen shoulders, and bicortical iliac-crest bone was used in two;
                   - average glenoid version after grafting was 4° of retroversion, with an average correction of 33°;
                          - range of glenoid version was 22° of anteversion to 30° of retroversion
                   - graft failed to maintain the original correction in three shoulders due to nonunion, dissolution, or shift;
                   - 5 total shoulder replacements failed, necessitating glenoid revision at two to ninety-one months postoperatively;
                          - failures were associated with recurrent massive cuff tears (one shoulder), persistent instability (two shoulders), improper component placement (one shoulder), and loss of graft fixation (one shoulder);
                   - grafts that were used for posterior defects were technically more difficult to place and transfix than were those used for anterior defects;
                          - 1/5 components that had been inserted with an anterior graft failed;
                          - 4/12 components that had been inserted with a posterior graft failed;
                   - according to the criteria of Neer et al., the functional result was rated as excellent in three shoulders, satisfactory in six, and unsatisfactory in eight;
                   - ref: Long-Term Results of Total Shoulder Arthroplasty Following Bone-Grafting of the Glenoid