Saturday, November 30, 2013

Technique for the reverse total shoulder for the BAT (bad arthritic triad)

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

This technique paper is authored by some true experts in reverse total shoulder arthroplasty and merits a close read. It deals with the use of the reverse total shoulder to manage the BAT (bad arthritic triad): glenoid retroversion+glenoid biconcavity+posterior subluxation of the humeral head on the glenoid. They point out that multiple authors have found unsatisfactory results with conventional total shoulder replacement in the presence of the BAT. Specifically, the authors recently published "Results of anatomic nonconstrained prosthesis in primary osteoarthritis with biconcave glenoid" in which they retrospectively evaluated 92 anatomic TSAs performed in 75 patients with primary osteoarthritis and a biconcave glenoid. At an average follow up of 77 months 15 revisions had been performed for glenoid loosening, posterior instability, or soft tissue problems. Only 66.3% of patients were very satisfied or satisfied. Glenoid loosening was observed in 20.6% and was significantly associated with the depth of posterior bone erosion and posterior humeral head subluxation.

We have provided a previous post on the results of this surgical technique.

We have found that some BAT shoulders can be managed with a ream and run procedure, however it older individuals with substantial glenoid bone loss the reverse total shoulder with a humeral head bone graft is a consideration as explained here.
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