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Anatomic Total Shoulder Arthroplasty With a Posterior Augment Glenoid Implant

March 01, 2020

Contributors: Charles Mitchell Jobin, MD, FAAOS; Michael Lee Knudsen, MD; Cesar David Lopez, BS

Posterior glenoid wear is common and usually is associated with glenoid osteoarthritis, which results in considerable pain and functional limitations. For patients with osteoarthritis in whom nonsurgical treatment fails, total shoulder arthroplasty affords pain relief and improved shoulder function. However, retroverted or misaligned implants are associated with poorer postoperative outcomes and an increased rate of complications. Various strategies are available for the correction of glenoid retroversion. Eccentric reaming of the anterior glenoid results in bone loss and joint line medialization. Studies have reported that primary bone grafting is associated with mixed results. The use of posterior augment glenoid implants is associated with good outcomes and minimizes anterior glenoid bone loss. Posterior augment glenoid implants allow for re-centering of the humeral head and preservation of the native joint. They are especially beneficial in specific patients, such as those with substantial posterior subluxation and patients with 15° to 25° of glenoid retroversion. Although no consensus exists with regard to the superiority of commercially available posterior augment glenoid implants, several studies have confirmed that wedged components are associated with better preservation of anterior glenoid bone compared with eccentric reaming. Wedge components also are beneficial in patients with a Walch type B2 glenoid. Contraindications to anatomic total shoulder arthroplasty with the use of a posterior augment glenoid implant include inadequate bone stock to support the implant, poor bone quality, osteoporosis, and active infection. This video demonstrates anatomic total shoulder arthroplasty with the use of a posterior augment glenoid implant. The goal of the procedure is to successfully correct glenoid retroversion and restore shoulder function and stability with the use of a wedged posterior augment glenoid implant. The video reviews indications, contraindications, and techniques for successful anatomic total shoulder arthroplasty. Preoperative imaging studies, operating room setup, patient positioning, surgical approach, postoperative management, and expected outcomes are described.