Shoulder Arthroplasty in the Presence of Posterior Glenoid Bone Loss

Abstract

➤ Chronic osteoarthritis of the glenohumeral joint, traumatic injury, post-reconstruction arthropathy, and developmental conditions such as glenoid dysplasia can result in posterior glenoid bone loss and excessive retroversion of the glenoid. Shoulder replacement in this setting is technically challenging and characterized by higher rates of complications and revisions.➤ Current options that should be considered for managing glenoid bone loss that results in >15° of retroversion include bone-grafting, augmented glenoid components, and reverse total shoulder replacement.➤ Asymmetric reaming is commonly used to improve version but should be limited to correction of 10° to 15° of retroversion in order to preserve subchondral bone.➤ Bone-grafting of glenoid defects has had mixed results and has been associated with graft-related complications, periprosthetic radiolucencies, and glenoid component failure; however, it provides a biologic option for patients with severe bone loss.➤ Implantation of an augmented polyethylene glenoid component offers the potential to improve version while preserving subchondral bone, but the procedure is technically demanding and without clinical follow-up data at this point.➤ Reverse total shoulder arthroplasty offers improved fixation and stability compared with an anatomic prosthesis for elderly patients with severe glenoid bone loss but is associated with a high complication rate.➤ Glenoid dysplasia is defined as a deformity that results in >25° of glenoid retroversion. Advanced imaging needs to be obtained in order to ensure enough glenoid bone stock is present to allow anatomic glenoid component placement.

Complications of Shoulder Arthroplasty

“…1-A and 1-B)1,54,71,72,131,142 . Efficacy regarding these surgical techniques remains largely unproven.loosening made up a majority of these events (217 [82%] of 264 shoulders) .…”

Glenoid hypoplasia

“…In milder cases, where glenoid retroversion is less than 15°, glenoid reaming remains an option if sufficient subchondral bone can be spared [15], [16]. Subchondral bone loss after glenoid reaming may impair implantation strength and may lead to joint line medialization.…”

“…Preoperative planning is guided by Walch classification [17]. Overall, shoulder surgeries correcting glenoid bone loss have an increased risk of complications when compared to the normal population [16].…”

“…Augmented glenoid components are possible treatments for glenoid retroversion exceeding 15° [16]. The use of these implants can spare the glenoid subchondral bone, but the installation procedure may be more technically challenging than others [16].…”

“…The use of these implants can spare the glenoid subchondral bone, but the installation procedure may be more technically challenging than others [16]. Suggested use of these devices has been determined by a range of posterior glenoid bone loss from 3 mm to 9 mm on axial view [19].…”