Does glenoid component version correlate with clinical outcome in aTSA?

Preoperarive glenoid retroversion is common in shoulders having anatomic total shoulder arthroplasty (aTSA). 

Some surgeons contend that - when performing aTSA - it is important to insert the glenoid component in 15 degrees or less retroversion. This is accomplished by eccentric reaming of the anterior glenoid bone, use of a posteriorly augmented glenoid component, or both. As shown below, this approach can come at the cost of removing robust glenoid bone,

An alternative approach is to preserve glenoid bone stock by accepting (rather than correcting) glenoid retroversion (shown in the lower half of the figure below),

And in this set of x-rays obtained 10 years after surgery

The authors of Does postoperative glenoid component retroversion following anatomic total shoulder arthroplasty affect clinical outcomes? A systematic review and meta-analysis reviewed the available evidence relating patient reported outcomes to the retroversion in which an anatomic glenoid component was inserted.  Fifteen articles (1,190 shoulders) reporting postoperative clinical outcomes and measurements of glenoid component version after primary anatomic shoulder arthroplasty were identified and submitted for meta-analysis. Patients were divided into 2 groups based on postoperative glenoid component retroversion: (a) < 15° and (b) ≥ 15°. When comparing patient reported outcome scores, range of motion, and complications for shoulders with <15 or ≥15 degrees of glenoid component retroversion, no clinically significant differences were noted between the 2 groups at a mean followup of 51 months. Specifically, the ASES scores, range of motion, complication rates, and revision rates were essentially identical. Shoulders with ≥15 degrees of retroversion had less radiolucency. Corrective (eccentric) reaming was associated with higher complication and revision rates.

Several other recent articles support these findings:

Does glenoid version and its correction affect outcomes in anatomic shoulder arthroplasty? A systematic review "There is currently insufficient evidence that pre- or postoperative glenoid version influences postoperative outcomes independent of other morphologic factors such as joint line medialization. Given that noncorrective reaming demonstrated favorable postoperative outcomes, and postoperative glenoid version was not significantly and consistently found to impact outcomes, there is inconclusive evidence that correcting glenoid retroversion is routinely required."

Anatomic total shoulder arthroplasty for posteriorly eccentric and concentric osteoarthritis: a comparison at a minimum 5-year follow-up "At a mean 8-year follow-up, the final SST score, change in SST score, and percentage of maximal improvement was not correlated with pre- and postoperative humeral head centering, Walch classification, or glenoid version." "Incomplete glenoid component seating was the greatest predictor of glenoid component radiolucency"

 

Glenoid retroversion does not impact clinical outcomes or implant survivorship after total shoulder arthroplasty with minimal, noncorrective reaming "Anatomic total shoulder replacement with minimal and noncorrective glenoid reaming demonstrates reliable increases in patient satisfaction and clinical outcomes at a mean of 4.6-year follow-up in patients with up to 40° of native retroversion. Higher values of retroversion were not associated with early deterioration of clinical outcomes, revisions, or failures."

Comment:

Substantial resources are being directed at measuring, planning for, and correcting preoperative glenoid retroversion when performing anatomic total shoulder arthroplasty. These recent studies question whether these efforts are of value to the patient when treating arthritic retroversion with aTSA.

What is the best orientation?

Red-tailed hawks in combat

Union Bay Natural Area

Oct 2021

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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).