Glenoid Augmentation With Humeral Head Autograft in Reverse Shoulder Arthroplasty: A Retrospective Study of an Innovative Technique.

Introduction  The use of reverse shoulder arthroplasty (RSA) is expanding for both primary and revision procedures. Advances in implant technology and preoperative planning have improved the ability to manage complex glenoid defects. Various options are available for addressing severe glenoid bone loss, including eccentric reaming, glenoid reconstruction with bone graft, and the use of augmented glenoid baseplates. However, metal augments are often expensive and lead to more waste and CO₂ emissions, adding to our carbon footprint. Humeral head autografts are an excellent alternative, as they preserve bone and incorporate very well. We conducted a retrospective study and described a new innovative technique when using humeral head autograft for glenoid bone loss in reverse shoulder arthroplasty.  Methods  A retrospective review of 24 patients who underwent glenoid augmentation using humeral head autografts for reverse shoulder arthroplasty from 2017 to 2024. The majority of the patients were female, with a mean age of 75.4 years. All patients had a preoperative CT scan to assess glenoid bone loss and were classified as per Walch's classification. All patients were operated on by two consultant shoulder surgeons. A femoral head allograft was available for all as a standby in case of poor bone quality in the humeral head; however, this was only used in one patient. The deltoid-splitting McKenzie approach and a Delta Xtend reverse shoulder system (DePuy) were used in all patients. The humeral head was prepared to match the glenoid defect. The graft was held in place with a K-wire, followed by Metagelene; a log peg was used in most cases. Clinical and radiological outcomes were assessed retrospectively. Results  Most patients (15) had central glenoid wear A2 as per the Walch classification. There was only one intraoperative complication of a calcar fracture, with no immediate postoperative complications. The average duration of follow-up was 48.8 months. All patients had significantly better range of motion postoperatively and an improvement in Oxford Shoulder Score. A total of 22 patients did not have any pain in the shoulder at the last clinic follow-up, with 100% patient satisfaction following the surgery. Graft was incorporated in all but two patients (89.5%). No patients required revision surgery. Conclusion  Our new technique described for glenoid augmentation with humeral head bone graft is an effective technique for addressing glenoid bone defects in reverse shoulder arthroplasty, with good functional outcomes at long-term follow-up.