Thursday, August 15, 2013

Glenoid dysplasia and shoulder arthroplasty

Shoulder arthroplasty for osteoarthritis secondary to glenoid dysplasia: an update

As prior posts point out (see here) the most common form of glenoid dysplasia is one in which the bone at the posterior inferior aspect of the glenoid fails to form properly. This results in irregular joint contact and lack of support for the humeral head leading to a combination of secondary arthritis, posterior instability, and severe glenoid retroversion.

These authors report on 22 shoulders having 8 hemiarthroplasties and 14 total shoulder arthroplasties between 1980 and 2008. Average follow-up was 6 years (range, 0.4 to 23.1 years). Of note is that these individuals are on average younger than those having shoulder arthroplasty for 'routine' osteoarthritis:  average age of 54 years.

4 of 8 shoulders undergoing hemiarthroplasty needed revision.
5 of 14 total shoulders required revision (2 for infection).

In our book, Practical Evaluation and Management of the Shoulder, we classified shoulder problems as A (we know the problem and have a good solution), B (we know the problem but do not have a good solution), and C (we know neither the problem nor the solution). 

Glenoid dysplasia is a B. Neither hemiarthroplasty, total shoulder arthroplasty, bone grafting, fusion, reverse or other methods have yielded dependable results.

Our approach is to discuss the problem with the patient in detail. We have the patient work steadfastly on non operative management with gentle external rotation and forward elevation stretching and external rotator strengthening to try to optimize balance, comfort and function. If surgery is discussed, we consider a hemiarthroplasty with use of an eccentric humeral head and rotator interval plication as necessary to control posterior translation, but again, these shoulders are anything but routine. To make matters worse, the problem is not infrequently bilateral!

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