Metal Augments in Shoulder Arthroplasty

Abstract

Severe glenoid bone loss is encountered in a subset of patients with different shoulder pathologies (i.e. osteoarthritis, rotator cuff arthropathy, inflammatory arthritis, failed primary arthroplasty, etc.) managed with shoulder arthroplasty. It creates a challenge for the shoulder reconstructive surgeon due to difficulty in restoring the normal glenoid bony anatomy, achieving stable fixation of the glenoid component, and is associated with increased complications and poor clinical outcomes. Current surgical techniques to reconstruct glenoid bone loss including eccentric reaming and/or bone grafting have limitations in severe cases. Porous metal augments (PMA) have been proposed as a potential solution because of their biomechanical properties similar to cancellous bone, reliable bone ingrowth, and provide stable fixation of orthopaedic implants. Extensive integration of PMA’s for the management of bone loss in hip and knee arthroplasty has yielded positive mid-term results and provides an optimistic future in shoulder arthroplasty. This chapter will outline the background of PMA’s and potential utilization in the management of severe glenoid bone loss in primary and revision shoulder arthroplasty.