The authors suggest that posterior glenoid bone loss presents a unique challenge with an increased risk of glenoid component failure. They conducted a systematic review of six studies reporting posterior glenoid bone-grafting to address the bone loss in patients undergoing anatomical total shoulder arthroplasty; the average followup was 5.7 years.
While 57% of the patients had an excellent postoperative Neer score, 28.7% had evidence of radiolucency and 35% had humeral head subluxation or instability. Thirteen patients (14%) underwent revision of the glenoid component by the time of the latest follow-up. Complications included component loosening, graft failure, subluxation, dislocation, broken screws, axillary nerve injury, infection and stiffness.
Comment: Posterior glenoid bone grafting is a technically difficult procedure for addressing posterior bone loss that has a substantial failure rate. In some cases this treatment may be worse than the disease. For example recent work has shown that B2 glenoids and glenoids with retroversion > 15 degrees can be satisfactorily managed with a standard glenoid component without bone graft and without the complications and revisions associated with bone grafting (see this link). Surgeons need to ask what pathoanatomy justifies using a bone graft.
Comment: Posterior glenoid bone grafting is a technically difficult procedure for addressing posterior bone loss that has a substantial failure rate. In some cases this treatment may be worse than the disease. For example recent work has shown that B2 glenoids and glenoids with retroversion > 15 degrees can be satisfactorily managed with a standard glenoid component without bone graft and without the complications and revisions associated with bone grafting (see this link). Surgeons need to ask what pathoanatomy justifies using a bone graft.
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