Tuesday, July 23, 2013

Reverse total shoulder for biconcave - B2 - glenoids

Reverse Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis in Patients with a Biconcave Glenoid

The authors point out that a biconcave glenoid in patients with primary glenohumeral osteoarthritis represents a surgical challenge because of the associated static posterior instability of the humeral head and secondary posterior glenoid erosion. 

The purpose of their study was to evaluate the clinical and radiographic results of 27 reverse total shoulder arthroplasties for the treatment of primary osteoarthritis in patients with a biconcave glenoid.
81% of the patients were female, and the mean age of the patients at the time of surgery was 74.1 years (range, sixty-six to eighty-two years). 

By CT scan the mean preoperative retroversion was 32°, and the mean subluxation of the humeral head with respect to the scapular axis was 87%. 

17 patients had a reverse shoulder arthroplasty without bone graft, whereas 10 had an associated bone graft to compensate for posterior glenoid erosion. 

Complications occurred in four patients (15%) and included early loosening of the glenoid component (one patient) and neurologic complications (three patients). Grade-1 or 2 scapular notching was present in ten shoulders (37%).

In our practice, we have not used a reverse total shoulder (or specially designed glenoids or posterior bone grafting) for the management of a B2 glenoid because of concern about the complication rate and the activity restrictions. For selected patients with this pathology, a ream and run may be a better option. Here are some posts showing how this approach can be effective

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