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Shoulder Arthroplasty in the Presence of Posterior Glenoid Bone Loss

February 19, 2016

Contributors: Scott Stephens, MD; Kevin Charles Paisley, DO; Michael A Wirth, MD; Anil K Dutta, MD; Daniel S Robertson, MD; Daniel S Robertson, MD

Chronic osteoarthritis of the glenohumeral joint; traumatic injury; post-reconstruction arthropathy; and developmental conditions, such as glenoid dysplasia, may result in posterior glenoid bone loss and excessive glenoid retroversion. Shoulder replacement in this setting is technically challenging and associated with higher rates of complications and revision surgery. Current treatment options that should be considered for the management of glenoid bone loss that results in >15° of retroversion include bone grafting, augmented glenoid components, and reverse total shoulder arthroplasty. Asymmetric reaming commonly is used to improve version but should be limited to correction of 10° to 15° of retroversion to preserve subchondral bone. Augmented glenoid components were designed as an alternative to eccentric reaming and bone grafting to compensate for posterior glenoid bone loss. The design of augmented glenoid components may have a substantial effect on the forces transferred to the implant. The development of a stepped, posteriorly augmented glenoid design places the component perpendicular to the vector of joint forces and improves biomechanical properties. This video presents a unique implant design that improves glenoid version and prevents implant perforation, joint line medialization, and subchondral bone loss. Implantation of the augmented glenoid is technically demanding and requires precise creation of a glenoid bone bed to seat the augmented glenoid.