Early to midterm outcomes of anatomic shoulder arthroplasty performed on dysplastic glenoids
These authors evaluated the outcomes of total shoulder arthroplasty (TSA) for Walch type C dysplastic
glenoids with standard (non-augmented) glenoid components compared with TSA for glenoids with concentric wear and minimal erosion (Walch type A1).
Type C morphology was defined as having a uniconcave glenoid with greater than 25 degrees of retroversion and characteristic features, including hypoplasia of the posteroinferior glenoid or capular neck and reduced glenoid depth, but without humeral head decentering on the face of the glenoid. See this link.
Twenty-nine patients met inclusion criteria of a preoperative Walch type C dysplastic glenoid, treatment with TSA using standard (non-augmented) glenoid components and a minimum of 2-years clinical follow-up. Importantly, at the time of surgery no effort was made to correct glenoid version through reaming or posterior bone graft.
A matched cohort of 58 patients with a type A1 glenoid and minimum of 2-years clinical follow-up for anatomic shoulder arthroplasty served as the control group. Matching was based on age, gender, BMI, shoulder dominance, and surgery date.
The mean follow-up for this study was 4.5 years (SD 2.6; range, 2-10).
Baseline measures were not significantly different between the Walch type C dysplastic group and the matched type A1 cohort.
The Walch type C group had no significant differences in ASES score, ASES pain, or SANE score compared to the matched type A1 cohort. The average percent of maximum possible improvement was 75% for each group.
In the patients with a type C glenoid, there were 4 postoperative complications in 29 patients including one patient that required revision to reverse shoulder arthroplasty (RSA) and one patient that revision to RSA was recommended, giving an overall complication rate of 14% and revision rate of 7%. The complications were aseptic glenoid loosening (2), isolated subscapularis failure (1), and superior migration of the humeral head (1).
In the matched cohort patients with a type A1 glenoid, there were 10 postoperative complications in 10 of 58 patients with 7 revisions to RSA, resulting in a 17% complication rate and a 12% revision rate. All 7 revisions were to RSA for aseptic glenoid loosening at a mean of 7 years from index TSA (range, 3 to 10 years). Three of these 7 patients required glenoid bone grafting at the time of revision. Additionally, 2 patients were found to have nerve palsies following surgery; one had a partial brachial plexopathy presenting as mild biceps and hand weakness that resolved at 2 months, and the other an axillary nerve palsy in which motion and strength returned at 6 months but sensation has not returned at 5 years.
There were no differences in the rate of radiographic lucencies or Lazarus scores.
These authors concluded that anatomic TSA using standard, non-augmented glenoid components reliably produced clinically significant improvements in pain and function and similar short to midterm outcomes in patients with Walch type C dysplastic glenoids compared to patients with type A1 glenoids.
Comment: This paper again demonstrates that changing glenoid version either through preparation of the glenoid bone or through the use of augmented glenoid components does not appear to be necessary, even in extreme cases of glenohumeral pathoanatomy. To see a related article, click on this link:
Our time tested approach to total shoulder arthroplasty is shown in this link.
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