Friday, January 24, 2014

The relationship of glenoid version to stability in shoulder arthritis, the bad arthritic triad

There has been a lot of interest in methods for 'correcting' glenoid version in performing total shoulder arthroplasty using anterior glenoid reaming, stepped or posteriorly augmented glenoid components, or posterior bone grafts. This interest in version correction probably results from the observation that retroverted plastic glenoids are at risk for failure from loosening or wear from the often associated posterior humeral subluxation on the glenoid. However, it has yet to be shown that 'correction' of glenoid version enhances should

er stability. In other words, glenoid retroversion is associated with posterior instability, but correction of retroversion may not correct the instability, which may be related to factors such as posterior soft tissue laxity and muscle imbalance.

Credit where credit is due. Gilles Walch and colleagues made this point in their 1998 articlePrimary glenohumeral osteoarthritis: clinical and radiographic classification. 

We quote from that paper: "…subluxation of the humeral head correlates with glenoid wear, and it is reasonable to suggest that subluxation causes the wear. This presents a problem which must be emphasized: when one corrects the posterior glenoid wear (using a glenoid component with or without a graft) the subluxation is not corrected. This therefore leaves the risk of recurrence and may be responsible for glenoid loosening due to the 'rocking-horse' mechanism described by Franklin et al."

As we have shown with the ream and run procedure, posterior subluxation can be managed by the use of eccentric humeral head components and rotator interval plication without changing glenoid version.

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