His axillary "truth" view, taken with the arm in a functional position of elevation, shows the humeral head sitting in the posterior concavity of a biconcave glenoid
With a usual amount of glenoid retroversion
And substantial posterior decentering of the humeral head on the face of the glenoid
The amount of decentering can be measured in terms of the amount of posterior displacement of the center of the humeral head in reference to the perpendicular bisector of a line segment connecting the anterior and posterior edges of the glenoid.
After discussion of the options, including an anatomic total shoulder and a reverse total shoulder, he elected to proceed with a ream and run.
A 56 diameter of curvature humeral head with a 18 mm thickness and anterior eccentricity was used. A 8 mm standard stem was secured with impaction grafting. The procedure was performed under a general anesthetic without a brachial plexus block.
The postoperative x-rays are shown below
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A 56 diameter of curvature humeral head with a 18 mm thickness and anterior eccentricity was used. A 8 mm standard stem was secured with impaction grafting. The procedure was performed under a general anesthetic without a brachial plexus block.
The postoperative x-rays are shown below
Assisted flexion was started on the evening of surgery. The patient was able to comfortably achieve 160 degrees.
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