Monday, December 9, 2013

Posterior glenoid wear and anatomic total shoulder

Biomechanical Impact of Posterior Glenoid Wear on Anatomic Total Shoulder Arthroplasty.

These authors point out the commonly encountered problem of posterior glenoid wear and its association with failure of anatomic total shoulder arthroplasty. Approaches to changing glenoid version have included anterior glenoid reaming, posterior bone graft and posteriorly augmented glenoids. They used a computer model to compare bone removed to correct three different sizes of posterior glenoid defects and also quantified the change in rotator cuff muscle length resulting from correction of each defect using three different glenoid designs.

They found that for each size defect, muscle shortening and medialization of the humerus was observed for both eccentric reaming and each augmented glenoid design (wedge and step cut).

Our comment: While posterior glenoid erosion is a recognized risk factor for glenoid components, it has yet to be shown that normalizing the glenoid version leads to better clinical results in total shoulder arthroplasty. It is possible that the thickened posterior polyethylene may not hold up against the loads applied by the forward flexed shoulder.

We continue to consider the ream and run as an option for appropriate candidates with posterior glenoid erosion, avoiding the risk of glenoid component failure and allowing high levels of function.

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