While it is possible to devote substantial amount of resources
to trying to classify and quantify the great variation in glenohumeral arthritic pathoanatomy,
to carry out extensive preoperative planning to develop patient-specific instrumentation and
to use specialized posteriorly augmented glenoid components,
we have found that the great majority of our patients are well served by a preoperative assessment that includes a standardized axillary view (avoiding a CT scan) and uses a standard all-polyethylene component. Here's an example of the preoperative and postoperative axillary "truth" views for a patient from yesterday's OR. On his first postoperative day he achieved 145 degrees of assisted elevation with no concern about posterior instability.
We've included below a reprise of a prior post demonstrating that routine "correction" of glenoid version, preoperative CT scans, and patient specific instrumentation may not be necessary in total shoulder arthroplasty.
A 76 year old man presented to us with severe right shoulder pain, stiffness and the x-rays shown below. While his AP view suggested straightforward osteoarthritis
He elected to proceed with a total shoulder using a standard glenoid component. At surgery we reamed the glenoid to a single concavity without trying to change glenoid version. We used an anteriorly eccentric humeral component and a rotator interval plication to optimize posterior stability. Immediately after surgery he was started on the standard total shoulder rehabilitation program with continuous passive motion and assisted flexion. At six weeks he started the supine press and active flexion.
At four months he has a comfortable shoulder, no problems with instability, active flexion over 120 degrees, and is continuing his rehab.
His four month films are shown below.
See also:
Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty?
That study analyzed the two year outcomes in 71 TSAs, comparing the 21 in a "retroverted" group (the glenoid component was implanted in 15° or greater retroversion (mean ± SD, 20.7° ± 5.3°)) with the 50 in the "non-retroverted group" (the glenoid component was implanted in less than 15° retroversion (mean ± SD, 5.7° ± 6.9°)). The results in the retroverted group were not inferior to those for the non-retroverted group. The mean (± SD) improvement in the SST (6.7 ± 3.6; from 2.6 ± 2.6 to 9.3 ± 2.9) for the retroverted group was not inferior to that for the nonretroverted group (5.8 ± 3.6; from 3.7 ± 2.5 to 9.4 ± 3.0). The percent of maximal possible improvement (%MPI) for the retroverted glenoids (70% ± 31%) was not inferior to that for the nonretroverted glenoids (67% ± 44%). The 2-year SST scores for the retroverted (9.3 ± 2.9) and the nonretroverted glenoid groups (9.4 ± 3.0) were similar (mean difference, 0.2; 95% CI, - 1.1 to 1.4; p = 0.697). No patient in either group reported symptoms of subluxation or dislocation. The radiographic results for the retroverted glenoid group were similar to those for the nonretroverted group with respect to central peg lucency (four of 21 [19%] versus six of 50 [12%]; p = 0.436; odds ratio, 1.7; 95% CI, 0.4-6.9), average Lazarus radiolucency scores (0.5 versus 0.7, Mann-Whitney U p value = 0.873; Wilcoxon rank sum test W = 512, p value = 0.836), and the mean percentage of posterior humeral head decentering (3.4% ± 5.5% versus 1.6% ± 6.0%; p = 0.223). The percentage of patients with retroverted glenoids undergoing revision (0 of 21 [0%]) was not inferior to the percentage of those with nonretroverted glenoids (three of 50; [6%]; p = 0.251).
That study analyzed the two year outcomes in 71 TSAs, comparing the 21 in a "retroverted" group (the glenoid component was implanted in 15° or greater retroversion (mean ± SD, 20.7° ± 5.3°)) with the 50 in the "non-retroverted group" (the glenoid component was implanted in less than 15° retroversion (mean ± SD, 5.7° ± 6.9°)). The results in the retroverted group were not inferior to those for the non-retroverted group. The mean (± SD) improvement in the SST (6.7 ± 3.6; from 2.6 ± 2.6 to 9.3 ± 2.9) for the retroverted group was not inferior to that for the nonretroverted group (5.8 ± 3.6; from 3.7 ± 2.5 to 9.4 ± 3.0). The percent of maximal possible improvement (%MPI) for the retroverted glenoids (70% ± 31%) was not inferior to that for the nonretroverted glenoids (67% ± 44%). The 2-year SST scores for the retroverted (9.3 ± 2.9) and the nonretroverted glenoid groups (9.4 ± 3.0) were similar (mean difference, 0.2; 95% CI, - 1.1 to 1.4; p = 0.697). No patient in either group reported symptoms of subluxation or dislocation. The radiographic results for the retroverted glenoid group were similar to those for the nonretroverted group with respect to central peg lucency (four of 21 [19%] versus six of 50 [12%]; p = 0.436; odds ratio, 1.7; 95% CI, 0.4-6.9), average Lazarus radiolucency scores (0.5 versus 0.7, Mann-Whitney U p value = 0.873; Wilcoxon rank sum test W = 512, p value = 0.836), and the mean percentage of posterior humeral head decentering (3.4% ± 5.5% versus 1.6% ± 6.0%; p = 0.223). The percentage of patients with retroverted glenoids undergoing revision (0 of 21 [0%]) was not inferior to the percentage of those with nonretroverted glenoids (three of 50; [6%]; p = 0.251).
Here is the two year radiographic followup on a 55 year old patient from our practice. Preoperative films show a type B2 genoid with retroversion, biconcavity and posterior humeral subluxation.
Here are the 2 year films of this shoulder after conservative shoulder arthroplasty using a standard glenoid component without attempts to modify glenoid version. The humeral head is centered in the prosthetic glenoid. At two years after surgery the patient was able to perform all 12 functions of the Simple Shoulder Test.
Note that sufficient bone stock remains to perform a revision total or a reverse total shoulder arthroplasty shoulder these procedures become necessary in the future of this young person.
Long term followup of well-characterized patients treated with the different methods for managing glenoid retroversion will be required to define the relative risks, benefits, effectiveness and durability of each of them.
Long term followup of well-characterized patients treated with the different methods for managing glenoid retroversion will be required to define the relative risks, benefits, effectiveness and durability of each of them.
The reader may also be interested in these posts:
Information about shoulder exercises can be found at this link.
Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'See from which cities our patients come.
