In a previous post, we discussed two surgical approaches to the arthritic glenoid with increased retroversion (see this link).
One approach is to accept glenoid retroversion and reaming only enough achieve a single concavity of the desired curvature
Any excessive humeral translation is managed with an anteriorly eccentric humeral head and / or rotator interval plication.
Another approach is to correct glenoid retroversion with either a posteriorly augmented glenoid component (below left) or with eccentric reaming, removing bone from the anterior glenoid (below right).
Currently some surgeons routinely use three-dimensional preoperative planning based on CT scans to determine the amount of correction desired and the means of achieving it.
Recently, the authors of : Does Glenoid Version and its Correction Impact Outcomes in Anatomic Shoulder Arthroplasty – a Systematic Review looked at the published evidence on the effect of preoperative and postoperative glenoid retroversion on functional and radiological outcomes in patients who underwent anatomic total shoulder arthroplasty.
According to their analysis:
None of the studies that analyzed the effect of preoperative glenoid version on patient reported outcomes found a significant association on multivariable analysis.
None of studies that analyzed the effect of postoperative retroversion on patient reported outcomes found a significant association.
None of the studies that analyzed the effect of preoperative or postoperative retroversion on radiographic outcomes found a significant association when the results were controlled for the duration of followup.
These authors concluded that their most important finding is that there is a paucity of evidence comparatively analyzing whether correcting glenoid retroversion influences postoperative outcomes. Given that non-corrective reaming demonstrated favorable postoperative outcomes and that postoperative glenoid version was not consistently found to impact outcomes, there is inconclusive evidence that glenoid retroversion correction should routinely be required.
Interestingly, Static posterior humeral head subluxation and total shoulder arthroplasty found that re-centering of the humeral head on the glenoid was not correlated with glenoid version or its correction.
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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).
