Augments vs. Bone Grafting for Glenoid Deformity

Should shoulder surgeons use bone graft or augmented baseplates to address severe glenoid deformity with reverse shoulder arthroplasty?

Treating patients with significant glenoid bone loss is one of the most difficult challenges in reverse shoulder arthroplasty (rTSA). Traditionally, surgeons have fabricated bone grafts to restore the joint line for patients with glenoid bone loss, which is technically demanding and introduces new failure modes of graft resorption and/or fracture. Colasanti and colleagues decided to compare this old technique against a more modern technique using augmented baseplates, reviewing midterm results from a large multicenter registry. They analyzed 520 primary rTSA patients who received augmented baseplates and compared outcomes head-to-head with 47 patients with glenoid bone graft. Their goal was to determine which approach offered the best clinical performance, the fewest complications and the most efficient workflow for surgeons.

• Better clinical outcomes: The augmented baseplate patients achieved significantly better outcomes for nearly all clinical scores, including ASES, Constant and Smart Score, compared to bone graft patients.
• Better range of motion: The augmented baseplate patients achieved significantly more motion for nearly all measurements, including abduction, forward elevation and external rotation, compared to bone graft patients.
• Dramatic efficiency gains: Using an augmented glenoid baseplate instead of bone graft resulted in 50% less total intraoperative time and 33% less blood loss.
• Fewer complications: The augment cohort had three-fold less scapular notching (7% vs. 21%) and significantly lower rates of aseptic loosening (0.6% vs. 4.9%).
• 8x reduction in revisions: Only 1.7% of the augment baseplate patients required revision, compared to a 12.8% revision rate in the bone graft patients.
• Higher patient satisfaction: More augmented baseplate patients reported being “much better” following their surgery compared to bone graft patients.

Better Range of Motion and Clinical Outcome Scores

Correcting multi-planar glenoid bone loss using augmented baseplates resulted in superior outcomes compared to contoured bone autografts. The simpler technique not only saves critical time in the OR but also results in more durable fixation and improved function.

These findings are limited because they come from a single platform shoulder system; also, bone graft patient follow-up was significantly longer than for augmented baseplate patients.