Comparison of Asymmetric Reaming versus a Posteriorly Augmented Component for Posterior Glenoid Wear and Retroversion: A Radiographic Study

Document Type : RESEARCH PAPER


1 Orthopedic Physician Associates at Swedish Orthopedic Insitiute, Seattle, WA, USA

2 The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA

3 Ohio State University, Wexner Medical Center, Columbus, OH, USA

4 Brown University, Providence, RI, USA

5 OrthoCarolina, Charlotte, NC, USA


Background: Managing posterior glenoid wear and retroversion remains a challenge in shoulder arthroplasty.
Correcting glenoid version through asymmetric reaming (AR) with placement of a standard glenoid component and the
use of posteriorly augmented glenoid (PAG) components are two methods used to address this problem. Our objective
is to report the radiographic outcomes of patients with posterior glenoid wear and/or retroversion treated with either
Methods: Patients with posterior glenoid wear and a minimum of 15 degrees of retroversion, treated with AR and
standard glenoid component or with a PAG component (3 mm, 5 mm, or 7 mm posterior augmentation), were
consecutively identified through retrospective chart review. Pre-operative axillary views were evaluated for version,
humeral head subluxation in relation to scapular axis and to mid-glenoid face. Post-operative axillary views were
reviewed to measure corrected inversion and humeral head subluxation.
Results: There were 48 patients in the AR group and 49 patients in the PAG group. Version improved 6.8 degrees in the
AR group. In the PAG group, version improved 8.8 degrees with 3 mm augment, 13.4 degrees with 5 mm augment, and
12.8 with 7 mm augments. There were significantly more central peg perforations in the 5 mm PAG group compared
to other groups. The humeral head was re-centered within 6.1% of normal in all groups except 7 mm augments.
Conclusion: This study demonstrates that AR and PAGs have the ability to re-center the humeral head when utilized
in patients with retroversion and posterior wear. Use of a PAG component may allow for greater correction of glenoid
retroversion, however, there is an increased risk for central peg perforation with the specific implant utilized in this study.
Long-term follow-up is ongoing and needed to understand the clinical implications of these findings.
Level of evidence: IV


Main Subjects

1. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing
incidence of shoulder arthroplasty in the United
States. J Bone Joint Surg Am. 2011; 93(24):2249-54.
2. Walch G, Badet R, Boulahia A, Khoury A. Morphologic
study of the glenoid in primary glenohumeral
osteoarthritis. J Arthroplasty. 1999; 14(6):756-60.
3. Iannotti JP, Norris TR. Influence of preoperative
factors on outcome of shoulder arthroplasty for
glenohumeral osteoarthritis. J Bone Joint Surg Am.2003; 85(2):251-8.
4. Walch G, Moraga C, Young A, Castellanos-Rosas J.
Results of anatomic nonconstrained prosthesis in
primary osteoarthritis with biconcave glenoid. J
Shoulder Elbow Surg. 2012; 21(11):1526-33.
5. Couteau B, Mansat P, Estivalezes E, Darmana R, Mansat
M, Egan J. Finite element analysis of the mechanical
behavior of a scapula implanted with a glenoid
prosthesis. Clin Biomech. 2001; 16(7):566-75.
6. Farron A, Terrier A, Buchler P. Risks of loosening of
a prosthetic glenoid implanted in retroversion. J
Soulder Elbow Surg. 2006; 15(4):521-6.
7. Terrier A, Buchler P, Farron A. Influence of
glenohumeral conformity on glenoid stresses after
total shoulder arthroplasty. J Shoulder Elbow Surg.
2006; 15(4):515-20.
8. Clavert P, Millett PJ, Warner JJ. Glenoid resurfacing:
what are the limits to asymmetric reaming for
posterior erosion. J Shoulder Elbow Surg. 2007;
9. Gillespie R, Lyons R, Lazarus M. Eccentric reaming
in total shoulder arthroplasty: a cadaveric study.
Orthopedics. 2009; 32(1):21.
10. Hsu JE, Ricchetti ET, Huffman GR, Iannotti JP, Glaser DL.
Addressing glenoid bone deficiency and asymmetric
posterior erosion in shoulder arthroplasty. J Shoulder
Elbow Surg. 2013; 22(9):1298-308.
11. Sabesan V, Callanan M, Sharma V, Iannotti JP. Correction
of acquired glenoid bone loss in osteoarthritis with a
standard versus an augmented glenoid component. J
Shoulder Elbow Surg. 2014; 23(7):964-73.
12. Iannotti JP, Lappin KE, Klotz CL, Reber EW, Swope SW.
Liftoff resistance of augmented glenoid components
during cyclic fatigue loading in the posterior-superior
direction. J Shoulder Elbow Surg. 2013; 22(11):1530-6.
13. Kidder JF, Rouleau DM, Pons-Villanueva J, Dynamidis
S, Defranco M, Walch G. Humeral head posterior
subluxation on CT scan: validation and comparison
of 2 methods of measurement. Tech Shoulder Elbow
Surg. 2010; 11(3):72-6.
14. Mori D, Abboud JA, Namdari S, Williams GR. Glenoid
bone loss in anatomic shoulder arthroplasty:
literature review and surgical technique. Orthop Clin
Nortm Am. 2015; 46(3):389-97.
15. Hsu JE, Namdari S, Baron M, Kuntz AF, Abboud JA,
Huffman GR, et al. Glenoid perforation with pegged
components during total shoulder arthroplasty.
Orthopedics. 2014; 37(6):587-91.
16. Noyes MP, Meccia B, Spencer EE Jr. Five- to ten-year
follow-up with a partially cemented all-polyethylene
bone-ingrowth glenoid component. J Shoulder Elbow
Surg. 2015; 24(9):1458-62.
17. Schumaier A, Abboud J, Grawe B, Horneff JG,
Getz C, Romeo A, et al. Evaluating glenohumeral
osteoarthritis: the relative impact of patient age,
activity level, symptoms, and kellgren-lawrence grade
on treatment. Arch Bone Jt Surg. 2019; 7(2):151-60.