Vani Sabesan1, Vinay Sharma1, Mark Callanan2, Jason Ho3, Joseph Iannotti3. 1. Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008. E-mail address for V. Sabesan: sabes001@gmail.com. 2. Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, White 535, Boston, MA 02114. 3. Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195.
Abstract
INTRODUCTION: We describe a bone-graft technique, for shoulder arthroplasty in patients with severe glenoid bone loss, that utilizes a "step cut," a trapezoidal bone wedge from the resected humeral head, and graft fixation with screws placed from posterior to anterior through the graft. STEP 1 PREOPERATIVE PLANNING: Carry out preoperative planning for the step-cut procedure. STEP 2 SURGICAL APPROACH AND PREPARATION OF THE GLENOID: Expose the glenoid for bone graft insertion, taking care to avoid excessive reaming. STEP 3 PREPARE THE GLENOID BONE GRAFT: Cut the appropriately sized glenoid bone graft from the resected humeral head. STEP 4 INSERT AND FIX THE GLENOID BONE GRAFT: Position the bone graft in the glenoid defect and stabilize it with screws. STEP 5 PREPARE THE GLENOID SURFACE: Create an even concave surface between the anterior aspect of the glenoid and the posterior aspect of the graft. STEP 6 PLACE THE GLENOID IMPLANT: Position the glenoid component following step-cut graft implantation. POSTOPERATIVE REHABILITATION: Postoperative rehabilitation is mostly the same as that for standard total shoulder replacement without bone-grafting. RESULTS: The range of motion improved significantly in our study of twelve patients (p < 0.001).IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: We describe a bone-graft technique, for shoulder arthroplasty in patients with severe glenoid bone loss, that utilizes a "step cut," a trapezoidal bone wedge from the resected humeral head, and graft fixation with screws placed from posterior to anterior through the graft. STEP 1 PREOPERATIVE PLANNING: Carry out preoperative planning for the step-cut procedure. STEP 2 SURGICAL APPROACH AND PREPARATION OF THE GLENOID: Expose the glenoid for bone graft insertion, taking care to avoid excessive reaming. STEP 3 PREPARE THE GLENOID BONE GRAFT: Cut the appropriately sized glenoid bone graft from the resected humeral head. STEP 4 INSERT AND FIX THE GLENOID BONE GRAFT: Position the bone graft in the glenoid defect and stabilize it with screws. STEP 5 PREPARE THE GLENOID SURFACE: Create an even concave surface between the anterior aspect of the glenoid and the posterior aspect of the graft. STEP 6 PLACE THE GLENOID IMPLANT: Position the glenoid component following step-cut graft implantation. POSTOPERATIVE REHABILITATION: Postoperative rehabilitation is mostly the same as that for standard total shoulder replacement without bone-grafting. RESULTS: The range of motion improved significantly in our study of twelve patients (p < 0.001).IndicationsContraindicationsPitfalls & Challenges.
Authors: Douglas D Nowak; Maher J Bahu; Thomas R Gardner; Marc D Dyrszka; William N Levine; Louis U Bigliani; Christopher S Ahmad Journal: J Shoulder Elbow Surg Date: 2009-05-31 Impact factor: 3.019
Authors: Jason J Scalise; Michael J Codsi; Jason Bryan; John J Brems; Joseph P Iannotti Journal: J Bone Joint Surg Am Date: 2008-11 Impact factor: 5.284