J Shoulder Elbow Surg. 2023 May 30:S1058-2746(23)00415-9. doi: 10.1016/j.jse.2023.04.020. Online ahead of print.
ABSTRACT
BACKGROUND: The purpose of this study is to report the clinical and radiological outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up.
METHODS: Following ethical approval (ref: 17/YH/0318), patients were identified and invited to participate. Inclusion criteria were: 1) severe glenoid bone loss necessitating the need for custom implants; and 2) patients with definitive glenoid and humeral components implanted more than 2 years prior. Included patients underwent clinical assessment utilizing the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Surgeons score (ASES), and quick Disabilities of the Arm, Shoulder, and Hand Score (QuickDASH). Radiographic assessment included AP and axial projections. Patients were invited to attend a CT scan to confirm osseointegration. Statistical analysis utilized descriptive statistics (mean and standard deviation) and paired t test for parametric data.
RESULTS: Eleven patients declined to participate. 5 patients were deceased prior to study commencement, leaving 42 remaining patients in this analysis. Three patients had revision surgery prior to the 2-year follow-up. Of these, 2/3 retained their custom glenoid components. Mean follow-up was 31.6 months from surgery (range 24-52 months). OSS improved from a mean 15 (SD±8.4) to 36 (SD±12) (p < 0.001). Constant-Murley score improved from mean 15 (SD± 11.2) to 52 (SD± 20.1) (p < 0.001). QuickDASH improved from mean 70 (SD ±21) to 31 (SD ±24.8) (p = 0.004). ASES improved from mean 22 (SD± 17.8) to 71 (SD ±23.3) (p = 0.007). Radiological evaluation demonstrated good osseointegration in all but one included patient.
CONCLUSION: The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex cohort. Large complex glenoid bone defects can be managed successfully with custom 3D-printed glenoid components.
PMID:37263477 | DOI:10.1016/j.jse.2023.04.020
