A 60 year old healthy patient presented with pain and stiffness of the left shoulder and these x-rays showing a posteriorly decentered humeral head on a retroverted, biconcave (B2) glenoid with posterior bone loss.
No preoperative CT scan or MRI was obtained.
The patient elected an anatomic total shoulder arthroplasty without a brachial plexus block.
This was performed with minimal glenoid reaming, a standard, non-augmented all-polyethylene glenoid component and an impaction grafted standard stemmed humeral component (see this link). See Anatomic Total Shoulder Arthroplasty with All-Polyethylene Glenoid Component for Primary Osteoarthritis with Glenoid Deficiencies
At six weeks after surgery the patient was pleased with comfortable active elevation of 160 degrees and these radiographs showing centering of the humeral head on the glenoid component.
Comment: As pointed out in a prior post (see this link), the value of a shoulder arthroplasty can be increased by reducing the associated costs. In this case, the value of this procedure was optimized by avoiding the costs of approaches that might have been used, including a CT scan, a plexus block, an augmented glenoid component and a reverse total shoulder.
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