The Evolution of the Walch Classification for Primary Glenohumeral Arthritis
These authors provide an interesting and comprehensive narrative of the efforts to describe glenohumeral arthritic pathoanatomy. They recognize the early work of Neer, who pointed out the widely varying patterns of glenoid erosion and the associated changes in effective version of the glenoid with respect to the body of the scapula: central erosion without change in glenoid version, anterior wear with effective glenoid anteversion, posterior wear with effective glenoid retroversion, and superior wear with effective superior inclination. They acknowledge the important efforts of Walch, Friedman, Levy and others to classify the different forms of arthritic glenohumeral pathoanatomy. These efforts at classification required the postulations of "dividing lines" between the different classifications. Looking at the early Walch classification for example
it is necessary to decide how much medial erosion is necessary before an A1 becomes and A2, how much biconcavity is necessary before a B1 becomes a B2, how much posterior erosion is necessary before an A2 becomes a B2. And what is to be done with the in betweenners:
Varying methods of imaging and various applications of dividing lines have lead to inter observer variability in classification. This variability continues as an increasing number of "types" are identified: B0, B3, D, C1, C2, E1, E2, etc. As the authors point out, since modifications of the Walch classification have been introduced, the kappa scores for both interobserver and intraobserver reliabilities are not as high as initially hoped for. In their paragraph "What the Future Holds", the authors predict that attempts to "classify" glenohumeral pathoanatomy will give way to the characterization an arthritic glenoid using simple quantitative measurements of glenoid version, glenoid inclination, the percentage of decentering of the humeral head on the articular surface of the glenoid (as shown below in an early diagram from Walch et al).
The use of these quantitative measurements should facilitate reproducible characterization of glenohumeral pathoanatomy. Critical issues remain, principally how much time and money and radiation need to be expended in characterizing the glenohumeral pathoanatomy prior to shoulder arthroplasty in the usual case. We have found that in the great majority of cases, a simple series of three plain radiographs (see this link) provides the needed information to plan anatomic and reverse total shoulder arthroplasty and to sequentially evaluate the shoulder after arthroplasty. How you can support research in shoulder surgery Click on this link.
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 total shoulder arthroplasty (see this link). The ream and run technique is shown in 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).
