Sunday, June 30, 2013

Glenoid retroversion in shoulder arthritis

Addressing glenoid bone deficiency and asymmetric posterior erosion in shoulder arthroplasty

This article reviews the challenge of the retroverted glenoid, which is frequently encountered in shoulder arthroplasty - especially in osteoarthritis, capsulorrhaphy arthropathy, and glenoid dysplasia. Glenoid retroversion creates the risk of posterior instability and of rocking horse loosening of an implanted glenoid component. Glenoid version is most commonly assessed on a standardized axillary view. While there is interest in using CT and even 3D reconstructions for measuring the degree of accuracy of measurements of glenoid version, there is little evidence that the clinical management of patients with shoulder arthritis is enhanced by the increased cost and radiation of a CT scan. In addition to the glenoid version, the shape of the glenoid and position of the humeral contact point are also important variables that need to be managed at the time of shoulder arthroplasty.

The options in managing glenoid retroversion are several, including hemiarthroplasty alone, the ream and run procedure, total shoulder arthroplasty and reverse total shoulder. The authors of this paper do a nice job of reviewing the challenges of prosthetic glenoid arthroplasty in the face of posterior glenoid deficiency, pointing to the increased risk of loosening, instability and need for revision. They point out that surgeons commonly attempt to 'correct' glenoid retroversion, but also point out that the clinical effectiveness of changing the version by asymmetric reaming, bone grafting or the use of posteriorly augmented glenoid components remains to be demonstrated. Indeed, soft tissue balancing may be more important than version correction in these situations.


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