Friday, November 30, 2012

Accuracy of obtaining optimal base plate declination in reverse shoulder arthroplasty JSES

Accuracy of obtaining optimal base plate declination in reverse shoulder arthroplasty JSES

In this paper the authors describe a method for measuring the inclination/declination of the glenoid in relation to a reference line from the superior medial angle of the scapula to the superior margin of the glenoid. Unfortunately this reference line is not accessible in the OR. We note that there are a number of different references for measuring glenoid inclination and that the reference framework for the 'conventional wisdom' that the ideal position for the baseplate include 15 degrees of declination is not clear. As the authors point out, the reference cannot be the inconsistent orientation of the face of the preoperative glenoid, which in their study varied from -27 to + 28 degrees. Even in their experienced hands, the postoperative inclination of the baseplate varied widely from -23 to 44 degrees.

In our approach, we are less concerned about declination and more concerned about the superior/inferior position of the glenoid, the freedom from contact between the adducted humeral component and the scapula, and preserving quality bone on which the baseplate can be placed, recognizing that in prior studies, we have shown that the quality of bone on which the base plate is placed may be a critical determinant of the strength of fixation. Thus one must be cautious about reaming away bone of good quality to achieve a desired declination.


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