These authors describe the short-term functional and radiographic outcomes after total shoulder arthroplasty (TSA) in shoulders with a B2 glenoid addressed with "partially corrective" glenoid reaming.
Functional outcome scores were available for 59 of 92 eligible subjects (64%) at a mean of 50 months.
The mean preoperative retroversion measured 18° (range, –1° to 36°) and posterior subluxation was 67% (range, 39%-91%).
The Simple Shoulder Test scores improved from 4.5 to 9.1.
At a mean of 31 months, 38 had no glenoid radiolucent lines, 13 glenoids had grade 1, 2 had grade 2, and 5 had grade 3 lucencies.
There was no difference in the rate of progression of glenoid radiolucencies between shoulders with a preoperative glenoid version of ≤20° (27.8%) compared with glenoids with >20° of retroversion (22.7%, P = .670). The postoperative glenoid version was not reported.
Comment: One of the striking features of this series is the range of glenohumeral pathoanatomy within the authors' type B2 classification. The version ranged from one degree of anteversion to 36 degrees of retroversion. The posterior subluxation ranged from 39% to 91%. This drives home the difficulty in categorizing glenoids to discrete categories when critical parameters, such as the version, subluxation and degree of erosion vary along a continuous spectrum.
A difficulty with this study is the lack of documentation of the postoperative version. The technique defined included the statement "In more severe deformities, the implant was placed slightly more retroverted in favor of excessive reaming, which would compromise glenoid fixation."
In one of the cases (shown below) the postoperative version on the true axillary measures 25 degrees.
It would be of interest to know the postoperative version and the degree of version correction in these cases.
Readers interested in the clinical effects of postoperative version should read this post: How important is correcting glenoid version anyway? (link) which discusses the article
Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty? (link). The conclusion was that postoperative glenoid retroversion was not associated with inferior clinical results at 2 years after surgery.
Does Postoperative Glenoid Retroversion Affect the 2-Year Clinical and Radiographic Outcomes for Total Shoulder Arthroplasty? (link). The conclusion was that postoperative glenoid retroversion was not associated with inferior clinical results at 2 years after surgery.
As stated in the previous post, long term followup is need to determine the durability of the glenoid component in total shoulder arthroplasty and to define the factors associated with glenoid loosening. At this point, however, it is not clear how much "correction" of glenoid version affects the outcome of shoulder arthroplasty.
One final comment relates to the use of the term "subluxation". The authors use the example below to show a case of "74% posterior subluxation".
In our practice we find it clearer to define posterior decentering of the humerus on the glenoid using a standardized axillary view and measure the humeral contact position ratio as the ratio of the distance between the front of the glenoid and the point of humeral contact to the distance between the anterior and posterior lips of the glenoid.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
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