The Evolution of the Walch Classification for Primary Glenohumeral Arthritis

Abstract

Our understanding of the pathology of and treatment for glenohumeral arthritis (GHA) has grown dramatically in the past few decades. Original observations regarding patterns of glenoid erosion, glenoid retroversion, and posterior humeral head subluxation in patients with primary GHA were documented in the 1980s and early 1990s. In the late 1990s, Walch et al proposed what is now the most widely used classification system to describe the characteristic pathology of GHA. Improved understanding of both premorbid and pathologic anatomies, along with advancements in imaging, have steered modifications in this classification system. These changes have improved its reliability and helped to further guide management decisions. The purpose of this article is to review the evolution of the Walch classification, understand the rationale behind the modifications, and discuss potential future developments.

Mid-term results of the use of structural humeral head autograft to correct glenoid bone loss in reverse total shoulder arthroplasty

“…All patients treated surgically with the DJO/Encore Reverse Shoulder Prosthesis (DJO, Austin, TX, USA) augmented with a humeral head autograft were identified. These cases were further stratified according to the Walch classification (A2, B1, B2, B3, C1, C2, and D), 8 , 13 the Favard classification (E0, E1, E2, E3, and E4), 8 , 15 and whether they had concomitant rotator cuff insufficiency. The Walch and Favard classifications have only been validated for cases of primary osteoarthritis and massive rotator cuff tear, respectively.…”

“…Type B2, B3, C2, and D all involve moderate to severe bone loss with glenohumeral subluxation. 8 , 13 These morphologies can also be associated with bone loss to the glenoid vault depth, precluding implantation of a cemented standard glenoid component in anatomical shoulder arthroplasty, and reduced bone stock for implantation of reverse total shoulder ingrowth componentry. 8 , 18 It has been reported that up to 40% of patients with rotator cuff arthropathy present with superior bone loss to the glenoid.…”

Diagnosis and Management of Glenohumeral Arthritis in the Active Adult

“…Radiological loosening of the glenoid component is one of the most common complications of TSA, especially in patients with associated rotator cuff deficiency. Although literature exploring the correlation of the Walch classification to clinical outcomes after anatomic TSA is limited, this high rate of radiologically loosening suggests that the use of cemented polyethylene components should be avoided, especially in young patients who do more lifting and pulling 79,83 . Despite complications, a study by Favard et al shows low revision rates in most TSAs, good long-term clinical function, and a relatively high rate of satisfaction 79 .…”

Total Shoulder Arthroplasty Versus Reverse Shoulder Arthroplasty in Primary Glenohumeral Osteoarthritis With Intact Rotator Cuffs: A Meta-Analyses

“…Walch et al [ 6 ] described three glenoid wear patterns that have subsequently been expanded upon: A or concentric wear, B or posterior/eccentric wear, and C or dysplastic glenoids. B glenoids can be further described as B1 or monoconcave, B2 or biconcave glenoids, and B3 or monoconcave glenoids with posterior subluxation >70% or retroversion > 15% [ 7 ]. Glenoid deformity can influence treatment decisions with neoglenoid retroversion of greater than 27 degrees leading to an increased risk of glenoid component loosening [ 8 ].…”