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Revision Arthroplasty with Use of a Reverse Shoulder Prosthesis-Allograft Composite
Ariel Chacon, MD1; Nazeem Virani, MD2; Robert Shannon, MD3; Jonathan C. Levy, MD4; Derek Pupello, MBA1; Mark Frankle, MD1
1 Florida Orthopaedic Institute (A.C. and M.F.) and Foundation for Orthopaedic Research and Education (FORE) (D.P.), 13020 North Telecom Parkway, Tampa, FL 33637. E-mail address for M. Frankle: frankle@pol.net
2 Department of Orthopaedics and Sports Medicine, University of South Florida, 3500 East Fletcher Avenue, Suite 511, Tampa, FL 33613
3 Desert Orthopedics, 1303 N.E. Cushing Drive, Bend, OR 97701
4 Orthopaedic Institute at Holy Cross Hospital, 4725 North Federal Highway, Fort Lauderdale, FL 33308
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from DJO Surgical. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DJO Surgical). Also, a commercial entity (DJO Surgical) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at Florida Orthopaedic Institute, Tampa, Florida

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jan 01;91(1):119-127. doi: 10.2106/JBJS.H.00094
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Background: Patients with disabling pain and loss of shoulder function with associated proximal humeral bone loss following shoulder arthroplasty have limited reliable treatment options. Our objective was to report the results, obtained as part of a prospective outcomes study, of the use of a reverse shoulder prosthesis-allograft composite in these patients.

Methods: Between 2002 and 2005, 353 patients treated with a reverse shoulder prosthesis were enrolled in a prospective cohort study. Twenty-five patients received, in addition, a proximal humeral allograft for the management of severe proximal humeral bone loss, and they comprise the study group. The average bone loss measured 53.6 mm (range, 34.5 to 150.3 mm). Patients were followed clinically with use of the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and a scale with which the patients rated their satisfaction, and they were followed radiographically to detect mechanical failure, loosening, notching, and graft healing. All patients were followed for a minimum of two years (average, 30.2 months).

Results: The total average ASES score improved from 31.7 points preoperatively to 69.4 points at the time of follow-up (p < 0.0001), and the average SST score improved from 1.4 to 4.5 points (p < 0.0001). Nineteen patients (76%) reported a subjective good or excellent result, five reported a satisfactory result, and one reported that the result was unsatisfactory. The range of motion improved in forward flexion (from 32.7° to 82.4°; p < 0.0001), abduction (from 40.4° to 81.4°; p < 0.0001), and internal rotation. Radiographic evaluation at the time of final follow-up showed incorporation of the allograft in the metaphyseal region in 84% (twenty-one) of the twenty-five patients and incorporation of the allograft in the diaphyseal region in 76% (nineteen) of the patients. Four patients had complications.

Conclusions: Use of a reverse shoulder prosthesis-proximal humeral allograft composite for the treatment of shoulder dysfunction following arthroplasty associated with substantial proximal humeral bone loss has shown promising early results. The allograft may restore proximal humeral bone stock, thereby helping to maintain the height of the prosthesis bone construct and thus deltoid tension. Additional, long-term studies are needed to evaluate the longevity of this construct.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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