PMID- 36400341 OWN - NLM STAT- MEDLINE DCOM- 20230421 LR - 20230421 IS - 1532-6500 (Electronic) IS - 1058-2746 (Linking) VI - 32 IP - 5 DP - 2023 May TI - Augmented baseplates yield optimum outcomes when compared with bone graft augmentation for managing glenoid deformity during reverse total shoulder arthroplasty: a retrospective comparative study. PG - 958-971 LID - S1058-2746(22)00826-6 [pii] LID - 10.1016/j.jse.2022.10.015 [doi] AB - PURPOSE: The purpose of this study was to compare the outcomes of primary reverse total shoulder arthroplasty (rTSA) using glenoid bone grafting (BG rTSA) with primary rTSA using augmented glenoid baseplates (Aug rTSA) with a minimum 2-year follow-up. METHODS: A total of 520 primary rTSA patients treated with 8 degrees posterior glenoid augments (n = 246), 10 degrees superior glenoid augments (n = 97), or combined 10 degrees superior/8 degrees posterior glenoid augments (n = 177) were compared with 47 patients undergoing glenoid bone grafting for glenoid bone insufficiency. The mean follow-up was 37.0(+/-16) and 53.0(+/-27) months, respectively. Outcomes were analyzed preoperatively and at the latest follow-up using conventional statistics and stratification by minimum clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds where applicable. Radiographs were analyzed for baseplate failure, and the incidences of postoperative complications and revisions were recorded. RESULTS: The glenoid Aug rTSA cohort had greater improvements in patient-reported outcome measures (PROMs) and range of motion when compared with the BG rTSA group at a minimum of 2-year follow-up, including Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles score, Shoulder Pain and Disability Index score, shoulder function, Shoulder Arthroplasty Smart score, abduction, and external rotation (P < .05). Patient satisfaction was higher in the Aug rTSA group compared with the BG rTSA group (P = .006). The utilization of an augmented glenoid component instead of glenoid bone grafting resulted in approximately 50% less total intraoperative time (P < .001), nearly 33% less intraoperative blood loss volume (P < .001), approximately 3-fold less scapular notching (P < .01), and approximately 8-fold less adverse events requiring revision (P < .01) when compared with the BG rTSA cohort. Aside from SCB for abduction, the Aug rTSA cohort achieved higher rates of exceeding MCID and SCB for every PROM compared with BG rTSA. More specifically, 77.6% and 70.2% of the Aug rTSA achieved SCB for American Shoulder and Elbow Surgeons and Shoulder Pain and Disability Index vs. 55% and 48.6% in the BG rTSA, respectively (P = .003 and P = .013). CONCLUSION: The present midterm clinical and radiographic study demonstrates that the utilization of an augmented baseplate for insufficient glenoid bone stock is superior as judged by multiple PROMs and range of motion metrics when compared with bone graft augmentation at minimum 2-year follow-up. In addition, when analyzed according to MCID and SCB thresholds, the use of augmented baseplates outperforms the use of glenoid bone grafting. Complication and revision rates also favor the use of augmented glenoid baseplates over glenoid bone grafting. Long-term clinical and radiographic follow-up is necessary to confirm that these promising midterm results are durable. CI - Copyright (c) 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. FAU - Colasanti, Christopher A AU - Colasanti CA AD - Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. Electronic address: Christopher.Colasanti@Nyulangone.org. FAU - Lin, Charles C AU - Lin CC AD - Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Ross, Keir A AU - Ross KA AD - Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Luthringer, Tyler AU - Luthringer T AD - Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Elwell, Josie A AU - Elwell JA AD - Exactech, Inc., Gainesville, FL, USA. FAU - Roche, Christopher P AU - Roche CP AD - Exactech, Inc., Gainesville, FL, USA. FAU - Virk, Mandeep S AU - Virk MS AD - Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Simovitch, Ryan W AU - Simovitch RW AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, West Palm Beach, FL, USA. FAU - Routman, Howard D AU - Routman HD AD - The Palm Beach Shoulder Service, Atlantis Orthopaedics, Palm Beach Gardens, FL, USA. FAU - Zuckerman, Joseph D AU - Zuckerman JD AD - Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA. LA - eng PT - Journal Article DEP - 20221116 PL - United States TA - J Shoulder Elbow Surg JT - Journal of shoulder and elbow surgery JID - 9206499 SB - IM MH - Humans MH - *Arthroplasty, Replacement, Shoulder/adverse effects MH - *Shoulder Joint/surgery MH - *Glenoid Cavity/surgery MH - Retrospective Studies MH - Bone Transplantation/methods MH - Shoulder Pain/etiology MH - Treatment Outcome MH - Range of Motion, Articular OTO - NOTNLM OT - Reverse total shoulder arthroplasty OT - augmented glenoid baseplate OT - glenoid bone graft OT - glenoid bone loss OT - glenoid defect OT - glenoid deficiency EDAT- 2022/11/19 06:00 MHDA- 2023/04/21 06:41 CRDT- 2022/11/18 19:35 PHST- 2022/07/27 00:00 [received] PHST- 2022/10/03 00:00 [revised] PHST- 2022/10/12 00:00 [accepted] PHST- 2023/04/21 06:41 [medline] PHST- 2022/11/19 06:00 [pubmed] PHST- 2022/11/18 19:35 [entrez] AID - S1058-2746(22)00826-6 [pii] AID - 10.1016/j.jse.2022.10.015 [doi] PST - ppublish SO - J Shoulder Elbow Surg. 2023 May;32(5):958-971. doi: 10.1016/j.jse.2022.10.015. Epub 2022 Nov 16.