B3 glenoid in a 73 year old woman, 12 year followup

A 73 year old woman presented with pain and stiffness of the left shoulder. Her radiographs showed glenohumeral arthritis with a retroverted monoconcave (B3) glenoid. Her Simple Shoulder Test indicated that she could not sleep comfortably, reach the small of her back, lift eight pounds, toss, throw, wash back of her opposite shoulder or do her usual work. She had 120 degrees of active elevation with grade 5 strength.

       

After a discussion of the surgical options, she elected an anatomic total shoulder. This was performed without preoperative MRI, CT scan, 3D planning or brachial plexus block. The long head tendon of the biceps was preserved. Conservative glenoid reaming was performed with no attempt to alter glenoid version. A standard (non-augmented) glenoid component was used. A standard length smooth humeral stem was impaction-grafted into the humeral canal.

At 12 years after her arthroplasty at the age of 85, she reported being able to perform 8 of the 12 functions of the Simple Shoulder Test and was pleased with the outcome of her surgery.

Her x-rays at that time show secure fixation of the humeral and glenoid components with bony ingrowth between the fins of the central glenoid peg. Penetration of the anterior glenoid vault by the central peg is seen on the axillary view.

Comment: As pointed out by the authors of Anatomic Total Shoulder Arthroplasty with All-Polyethylene Glenoid Component for Primary Osteoarthritis with Glenoid Deficiencies, this standardized economical approach (minimal reaming, standard, non augmented, glenoid component) is effective across the range of glenoid types:

Humeral centering on the glenoid can be achieved

without change in glenoid version.

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