Friday, July 31, 2015

Total shoulder arthroplasty - glenoid bone deficiency

Treatment of Glenoid Bone Deficiency in Total Shoulder Arthroplasty A Critical Analysis Review

These authors off the following 'bullet points' on this topic.

"» Primary glenoid bone loss usually occurs in association with osteoarthritis characterized by a posterior wear pattern, whereas secondary glenoid bone loss usually occurs in association with trauma, glenoid loosening, and iatrogenic injury during revision.

» Proper preoperative imaging is critical to ascertain glenoid characteristics, including size, version, and vault depth.

» Treatment of glenoid bone loss is dependent on the degree of version correction that is required and consists of eccentric reaming, bone or polyethylene augmentation, or the use of reverse shoulder arthroplasty."

The key points are (1) posterior glenoid wear is common in arthritic shoulders, (2)  posterior glenoid wear is associated with posterior instability after total shoulder arthroplasty,  and (3) retroverted glenoid components may be more susceptible to loosening.

Comment: This article reviews much of the literature regarding glenoid wear. 

Some points not emphasized in the article need to be highlighted
(1) the commonest direction of glenoid wear is posterior inferior and not posterior, so that posteriorly augmented glenoid components may not match the defect.  
(2) while it is clear that posterior glenoid wear indicates more severe arthritic pathology and an increased risk of total shoulder failure, it has yet to be demonstrated that 'correcting' glenoid version by eccentric reaming, posterior bone grafting, posteriorly augmented glenoid components, or patient specific instruments yield better clinical results than conservative glenoid reaming to a single concavity and using eccentric humeral head components and rotator interval plication as necessary to manage posterior humeral instability.  See this related post.

And, of course, the ream and run is always an option if the surgeon is comfortable with the surgical technique.

An example:
Preoperative axillary from September 2013

Post operative axillary from December 2014


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You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'