Glenoid corticocancellous bone grafting after glenoid component removal in the treatment of glenoid loosening.

摘要

Nine patients underwent removal of a loose glenoid component and corticocancellous iliac crest autografting of the bony defect. No revision glenoid components were inserted. Eight bony defects were large, central, and cavitary, and one had an additional peripheral component. Patients were evaluated with a subjective assessment, Constant score, and radiographs at a mean follow-up of 30 months (range, 24-39 months). By use of Neer criteria, the result was considered satisfactory in 5 patients and unsatisfactory in 4. Functional improvement was modest, with the mean Constant score increasing from 46.3 to 49.9 points. Radiographs revealed a mean 4.1 mm of medialization of the humeral head within the glenoid (range, 1-11 mm). Two cases showed wear of the bone graft, thought to be induced by eccentric glenoid loading due to rotator cuff insufficiency. No other case demonstrated wear or graft resorption. One patient required reoperation for a massive rotator cuff tear; at the time of surgery, excellent glenoid bone continuity was observed, allowing implantation of a reverse prosthesis. Corticocancellous autografting appears to be a reliable procedure for restoration of glenoid bone stock after removal of a loose glenoid component. Although functional gains were modest, restoration of the glenoid bone component allows implantation if deemed necessary.