Saturday, April 12, 2014

Reaming the glenoid for total shoulder arthroplasty

A glenoid reaming study: how accurate are current reaming techniques?

The authors used plastic models of arthritic glenoids in an attempt to explore how the quality of the reamed surface was influenced by different reamers and by glenoid erosion patterns.

They found that for type A glenoids the center and direction of reaming were constant for all surgeons, whereas for type B glenoids the center and direction of reaming differed significantly between surgeons. The congruity of the reamed surface was better after flat reaming than after convex reaming. Whether the reamers were guided by a central K-wire or by a nipple had no significant effect on the reamed surface.

They concluded that reaming of a uniconcave glenoid is reproducible, but reaming of a biconcave glenoid was variable being influenced by the degree of erosion and deformity.

Comment: While it is recognized that the bad arthritic triad is a risk factor for glenoid component failure in total shoulder arthroplasty and while there is interest in means to 'correct' glenoid version in performing total shoulder arthroplasty we do not yet have evidence that 'normalizing' glenoid version (i.e. using asymmetrical reaming, glenoid grafting or augmented components) improves clinical outcomes of total shoulders. It is, however, recognized that aggressive reaming removes precious glenoid bone stock jeopardizing glenoid component fixation.

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