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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 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 degrees 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 degrees of retroversion in order 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 can 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 allows for improved biomechanical properties. The purpose of this presentation is to present a unique design that can improve glenoid version while preventing 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.