These authors focus on the biconcave (B2) glenoid, characterised by preservation of the anterior portion of the native glenoid with uneven put on of the posterior glenoid. They level to the significance of returning the humeral head to a centered place on the glenoid.
And 3D planning software program
Nevertheless, in reviewing their case instance one could make serval observations:
(1) the preoperative CT scan
didn’t reveal the pathoanatomy as clearly because the preoperative axillary view
(2) of their case instance of “corrective reaming”, the model of the glenoid was not modified from earlier than surgical procedure
to after surgical procedure
(three) the prosthetic humeral head is centered on the humeral head regardless of 30 levels of postoperative glenoid retroversion (measure it your self).
We conclude that what issues is centering of the humeral head on the glenoid and preservation of glenoid bone inventory. These objectives will be achieved in nearly all instances with out preoperative CT planning and with out “corrective reaming” or augmented glenoids.
Extra on this subject will be see right here:
Outcomes of anatomic complete shoulder arthroplasty in sufferers with extreme glenoid retroversion: a case-control examine
These authors used a case-controlled examine to judge the impact of extreme preoperative glenoid retroversion on medical and radiographic complete shoulder (TSA) outcomes utilizing a regular non-augmented glenoid element.
They in contrast 40 sufferers with greater than 20 of glenoid retroversion preoperatively (common follow-up, 53 months) vs. a matched cohort of 80 sufferers with lower than 20 of retroversion (common follow-up, 49 months). In all sufferers, the surgical approach, implant design, and postoperative rehabilitation protocol have been equivalent. Peg parts have been predominantly used until the glenoid vault was decided to be slender based mostly on preoperative imaging. There have been 2 keeled glenoid parts used within the retroversion group and 5 keeled glenoid parts used within the management group. The glenoid was ready utilizing noncannulated reaming instrumentation with a aim of making ready the glenoid floor to create a minimal of 80% bottom concentric assist with out violation of subchondral bone assist. In instances of eccentric put on, the glenoid was reamed to match the bottom of the glenoid element, sometimes preferentially reaming the anterior glenoid and partially correcting glenoid model. Sufferers have been matched based mostly on intercourse, age, indication, and prosthetic measurement.
No vital variations have been noticed within the postoperative radiographic findings. Postoperative glenoid model was not measured, so the diploma of “partial correction” isn’t identified.
The authors concluded that at midterm follow-up, preoperative extreme glenoid retroversion doesn’t seem to affect medical or radiographic outcomes of TSA utilizing a regular glenoid element.
This paper will be thought-about together with the one described beneath wherein postoperative glenoid retroversion was measured and located to not have a adverse impact on the result.
Whereas glenoid retroversion and posterior humeral head decentering are frequent preoperative options of severely arthritic glenohumeral joints, the connection of postoperative glenoid element retroversion to the medical outcomes of complete shoulder arthroplasty (TSA) is unclear. Research have indicated concern for inferior outcomes when glenoid parts are inserted in 15° or extra retroversion.
In a inhabitants of sufferers present process TSA in whom no particular efforts have been made to vary the model of the glenoid, these authors requested whether or not at 2 years after surgical procedure sufferers having glenoid parts implanted in 15° or higher retroversion had (1) much less enchancment within the Easy Shoulder Check (SST) rating and decrease SST scores; (2) greater percentages of central peg lucency, greater Lazarus radiolucency grades, greater imply percentages of posterior decentering, and extra frequent central peg perforation; or (three) a higher share having revision for glenoid element failure in contrast with sufferers with glenoid parts implanted in lower than 15° retroversion. They examined the data of 201 TSAs carried out utilizing a regular all-polyethylene pegged glenoid element
The authors concluded that on this collection of TSAs, postoperative glenoid retroversion was not related to inferior medical outcomes at 2 years after surgical procedure.
Long run followup of well-characterized sufferers handled with the completely different strategies for managing glenoid retroversion can be required to outline the relative dangers, advantages, effectiveness and sturdiness of every of them.