In some practices substantial time and resources are directed toward 3D planning for "correction" of glenoid version and for augmentation of the baseplate to achieve this "correction".

As indicated in Assessment of surgeon variability in preoperative planning of reverse total shoulder arthroplasty: a quantitative comparison of 49 cases planned by 9 surgeons

There is substantial variability among surgeons in how 3D plans and augmented baseplates are used. This article concluded that there was substantial variability both between surgeons and between rounds for individual surgeons when planning RTSA. They suggest that there was little consensus among the surgeons on optimal planning parameters.

The authors of Baseplate Retroversion does not affect Postoperative Outcomes following Reverse Shoulder Arthroplasty questioned whether baseplate version affects the outcome of RSA.

In their approach to reverse total shoulder arthroplasty (RSA), these authors seek to preserve glenoid bone stock without aiming for a certain degree of retroversion.

In this study, they aimed to evaluate the relationship between pre- and postoperative retroversion in

271 RSAs as well as determine the effect of glenoid retroversion on functional outcomes, range of motion, and postoperative complications.

Of note, female patients commonly had 15 or fewer degrees of retroversion preoperatively.

Implants included an onlay prosthesis (Zimmer Anatomical or the Tornier Aequalis Ascend Flex)

or an inlay prosthesis (DJO surgical Altivate Reverse).

161 patients had postoperative retroversion less than or equal to 15 degrees (Group A), and 110 patients had retroversion greater than 15 degrees (Group B). The mean change in pre- to postoperative retroversion was 1 and 4 degrees in Group A and B, respectively.

They noted no significant differences between groups in ASES, VAS, or SANE scores and no significant differences in postoperative range of motion. There was one baseplate failure in each group, and there was one patient in group B with asymptomatic radiographic loosening (baseplate at risk).

Comment: This article questions the value of modifying glenoid version in the conduct of routine reverse total shoulder arthroplasty. 3D planning may suggest the need for bone removal or special glenoid components to correct retroversion. It remains to be seen whether the required time and resources required leads to better outcomes for the patient.

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