Glenoid morphology rather than version predicts humeral subluxation: a different perspective on the glenoid in total shoulder arthroplasty JSES

Glenoid morphology rather than version predicts humeral subluxation: a different perspective on the glenoid in total shoulder arthroplasty JSES.

This is a very important article. It indicates that glenoid shape, rather than glenoid version is the key factor in determining whether or not the humeral head is centered in the glenoid. 

There has been a lot of press recently directed at 'correcting' increased glenoid retroversion to increase stability, but these authors point out that shoulders with retroversion and a single glenoid concavity usually have the humeral head centered in the glenoid fossa. Thus, reaming the glenoid to 'normalize' the version or the use of 'steptech' glenoid components may not be necessary and may even lead to instability if the humeral head does not follow the change in version.

The reason that retroversion is not necessarily associated with subluxation lies in the concavity compression mechanism of glenohumeral stability. As long as the ball is pressed into a suitable concavity, the shoulder is stable.

With the biconcave glenoid, however, the humeral head is pressed into the posterior concavity and remains there unless the biconcavity is corrected. The correction of posterior humeral subluxation and biconcavity with a ream and run is shown in this post.

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