Reverse Total Shoulder Arthroplasty With Humeral Head Autograft Fixed Onto Glenoid for Treatment of Severe Glenoid Retroversion

Figures

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  Fig 1. The left shoulder is externally rotated, and the humeral head (black arrows) is thoroughly exposed. By use of an electrocautery device, the position for the cut is marked at the proximal aspect of the humerus. After this, an oscillating saw is used (A, B) to cut the portion of the humeral head to be prepared into an autograft (C, white arrow).

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  Fig 2. The glenoid (arrow) is exposed in the left shoulder, and the amount of retroversion is then evaluated. A ruler is used to measure the height, width, and depth of the glenoid, and these measurements are then compared with the preoperative imaging evaluation. These measurements will be used to achieve the correct size of the graft.

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  Fig 3. Once the measurements of the glenoid have been performed in the left shoulder, attention is turned to the preparation of the graft on the back table. (A) By use of a surgical pen and ruler, the humeral head autograft to be prepared is outlined (arrow). (B) A combination of a small oscillating saw and high-speed burr is used to achieve the desired size and shape of the graft (arrow).

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  Fig 4. After preparation of the graft, two 0.057 K-wires (arrows) are drilled perpendicular to the humeral head autograft and parallel with one another. The wires will be used to provide transfer of the graft to the native glenoid in the left shoulder.

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  Fig 5. (A, B) If a sterile 3-dimensional model of the patient's glenoid is available, the graft (arrows) can be placed over the model to verify positioning and shape before fixation in the left shoulder. If adjustments to the graft that will be placed in the left shoulder are needed, they are performed at this time through use of a small oscillating saw and/or high-speed burr.

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  Fig 6. (A, B) The graft is transported into the native glenoid in the left shoulder. Once in the correct position, the K-wires are advanced into the native glenoid to provide provisional fixation and guide drilling. After this, 3.0-mm titanium headless compression screws (Arthrex; arrows) are used to definitively fix the autograft in place.

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  Fig 7. Anteroposterior postoperative radiograph of the left shoulder at 6 weeks after surgery showing appropriate healing and integration of the implant.