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Background: The purpose of this study is to compare the 90-day complications and readmission rates between patients undergoing total shoulder arthroplasty (TSA) in an ambulatory surgery center (ASC) with glenoid bone loss requiring an augmented glenoid component compared to patients without bone loss. Methods: This is a retrospective cohort study of patients undergoing outpatient TSA at an ASC (2018-2021). Readmission, direct transfer, and complications were recorded. Major and minor complications were compared. Secondary outcomes included operative time, estimated blood loss, range of motion, and patient-reported outcome measures. Results: There were 44 patients (45 shoulders) included in the study, 20 with augmented implants for glenoid bone loss and 25 nonaugmented with a concentric glenoid. There were no statistical differences in demographics. Two complications were seen in both the augmented and nonaugmented groups (10% vs. 8%). There were no readmissions or direct transfers. The augmented group had significantly increased preoperative glenoid retroversion (23° vs. 9°, P < .05), posterior humeral head subluxation (78% vs. 61%., P < .05), and longer operative time (124.4 min vs. 112.3 min., P < .05). Patient-specific instrumentation was used in 60% of augmented cases and 29% of nonaugmented cases. Conclusion: There was no significant difference in complications, direct transfers, or readmissions between patients with and without glenoid bone loss being treated in an outpatient ASC. The augmented group had significantly worse preoperative deformities, longer operative times, and increased utilization of patient-specific instrumentation. Outpatient TSA in the setting of glenoid bone loss requiring augmentation was found to be safe and effective at a stand-alone ASC.

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BACKGROUND: Chronic osteoarthritis can result in glenohumeral subluxation and loss of posterior glenoid bone. This can alter normal glenohumeral biomechanics and affect the stress placed on the glenoid implant after total shoulder arthroplasty. This study evaluated the clinical and radiographic results of an augmented all-polyethylene glenoid for the treatment of glenoid osteoarthritis in the presence of posterior glenoid bone loss and determined whether any failures or complications occurred with short-term follow-up. METHODS: During a 2-year period, 21 patients were treated with an augmented glenoid for an index diagnosis of osteoarthritis with a biconcave glenoid and average posterior glenoid bone loss of 4.7 mm. Clinical outcomes were recorded for the American Shoulder and Elbow Surgeons Shoulder Assessment, Simple Shoulder Test, and active motion. Radiographic analysis included glenoid version, humeral head subluxation, component seating, ingrowth, and loosening. RESULTS: Significant improvements were demonstrated for American Shoulder and Elbow Surgeons Shoulder Assessment (52.3), Simple Shoulder Test (8.1), forward flexion (50°), external rotation (32°), and pain. Radiographic improvements were found for glenoid version (12°), humeral scapular alignment (23%), and humeral glenoid alignment (8%). Central peg ingrowth was demonstrated in all patients, and complete component seating was achieved in 19 patients. No complications were encountered, and no clinical or radiographic failures were identified. CONCLUSION: Augmented polyethylene glenoid components demonstrated improved clinical outcome, without implant failure or complications, during short-term follow-up.

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BACKGROUND: Revision shoulder arthroplasty can be complicated by osseous and soft tissue deficiencies. Proximal humeral bone loss can result in diminished implant stability and reduced functional outcomes, and some studies have advocated the use of humeral allograft in this setting. This study compares the outcomes of revision reverse total shoulder arthroplasty (RTSA) in patients both with and without proximal humeral bone loss. METHODS: During a 6-year period, 32 patients were revised to RTSA for failed shoulder hemiarthroplasty. Proximal humeral bone loss was found in 16 patients, with an average loss of 36.3 mm (range, 17.2-66 mm). Patients were followed up an average of 51.2 months with the American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, visual analog scale score for pain, subjective outcome ratings, and radiographs. RESULTS: Significant improvement was found for average American Shoulder and Elbow Surgeons score (30.7 to 66.8), Simple Shoulder Test score (1.6 to 5.3), visual analog scale score (6.0 to 2.6), and forward flexion (51° to 100°) but not for external rotation (15° to 19.1°). No difference was demonstrated for functional or subjective outcomes compared with patients with intact humeral bone, except for active motion. On radiographic examination, 3 patients demonstrated humeral-sided loosening. Five complications were noted in patients with humeral bone loss. CONCLUSION: Revision RTSA can provide successful outcomes in the presence of proximal humeral bone loss without the use of allograft. Implant stability may be improved by the use of a cemented long-stem monoblock humeral prosthesis in revision settings.

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➤ Chronic osteoarthritis of the glenohumeral joint, traumatic injury, post-reconstruction arthropathy, and developmental conditions such as glenoid dysplasia can result in posterior glenoid bone loss and excessive retroversion of the glenoid. Shoulder replacement in this setting is technically challenging and characterized by higher rates of complications and revisions.➤ Current options that should be considered for managing glenoid bone loss that results in >15° of retroversion include bone-grafting, augmented glenoid components, and reverse total shoulder replacement.➤ Asymmetric reaming is commonly used to improve version but should be limited to correction of 10° to 15° of retroversion in order to preserve subchondral bone.➤ Bone-grafting of glenoid defects has had mixed results and has been associated with graft-related complications, periprosthetic radiolucencies, and glenoid component failure; however, it provides a biologic option for patients with severe bone loss.➤ Implantation of an augmented polyethylene glenoid component offers the potential to improve version while preserving subchondral bone, but the procedure is technically demanding and without clinical follow-up data at this point.➤ Reverse total shoulder arthroplasty offers improved fixation and stability compared with an anatomic prosthesis for elderly patients with severe glenoid bone loss but is associated with a high complication rate.➤ Glenoid dysplasia is defined as a deformity that results in >25° of glenoid retroversion. Advanced imaging needs to be obtained in order to ensure enough glenoid bone stock is present to allow anatomic glenoid component placement.

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