Friday, May 4, 2018

Preserving glenoid bone in total shoulder arthroplasty

Short-term radiographic results of a cemented polyethylene keeled glenoid component with varying backside radiuses of curvature

These authors analyzed the radiographic results of a cemented all-polyethylene keeled glenoid component available in different sizes and multiple backside radiuses of curvature implanted in 118 shoulders.

A type A1 glenoid was found in 28 shoulders, an A2 in 51, a B1 in 24, a B2 in 18, and a B3 in 4. The surgical technique included measuring the curvature of the arthritic glenoid and selecting a backside curvature that closely matched it so that minimal glenoid reaming was required.

Mean follow-up was 38 months. The mean radiolucent line score after surgery was 0.54 points and 90% had no or only 1 radiolucent line. At the final follow-up, the mean score was 1.06 points (range, 0-3 points) and 74% had no or only 1 radiolucent line. The radiolucent line score increased significantly over time. No component was at risk for loosening. No correlation was found between patient age, sex, hand dominance, glenoid morphology, or fatty infiltration of the rotator cuff muscles and the occurrence of radiolucent lines.

Comment: These authors have advocated an approach to glenoid arthroplasty that minimizes glenoid reaming and maximizes preservation of the subchondral glenoid bone.

It is interesting, however, that they do not describe how they managed the important problem of glenoid retroversion and biconcavity for the type "B" glenoids included in this study.

In performing prosthetic glenoid arthroplasty, our goal (like that of theses authors) is to minimize the amount of glenoid bone removed, striving to preserve the subchondral bone. We do not attempt to "correct" glenoid retroversion by eccentric reaming

In the presence of retroversion and a biconcave glenoid, we adjust the angle of the reamer to preserve glenoid bone stock while still providing a good match of the reamed glenoid bone to the backside of the glenoid component.

See this link:  
Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty?

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