AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Defectos Óseos Glenoideos en Artroplastia de Hombro-Xavier A. Duralde, MD

Defectos Óseos Glenoideos en Artroplastia de Hombro-Xavier A. Duralde, MD

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This document by Dr. Xavier A. Duralde from Peachtree Orthopaedic Clinic focuses on glenoid bone defects in shoulder arthroplasty, discussing classification, evaluation, surgical principles, and treatment strategies.<br /><br />Normal glenoid version averages around -1.23°, with variation in inclination. The Walch classification categorizes glenoid retroversion patterns into A (central wear), B (posterior wear, including biconcave glenoids), and C (hypoplastic glenoids with >25° retroversion). Glenoid loosening remains the leading cause of total shoulder arthroplasty (TSA) failure, occurring in up to 50% of cases radiologically by 10 years. Causes include improper implant positioning, superior tilt, excessive reaming, incomplete seating, and changed joint reaction forces.<br /><br />Radiographic evaluation alone is insufficient for assessing deformity; preoperative CT with 3D reconstruction is optimal to evaluate bone stock, version, and osteophytes. Computer-assisted implantation improves accuracy in correcting glenoid version.<br /><br />Surgical reconstruction aims to restore normal version (around 6-15° retroversion), preserve bone stock, and achieve full implant-bone contact. Excessive retroversion increases stress and complications. Options for glenoid deficiency include eccentric reaming (effective for retroversion ≤15° in about 90% of cases), bone grafting from the humeral head, augmented glenoid components, or reverse total shoulder arthroplasty (rTSA) for severe defects. Eccentric reaming has limitations, such as subchondral bone loss and increased wear. Bone grafting is technically demanding and has variable results. Augmented glenoids preserve subchondral bone and avoid medialization but need longer follow-up. Reverse TSA is considered for elderly patients with severe bone loss, offering good satisfaction but higher complication rates.<br /><br />Soft tissue balancing and capsular plication may be necessary adjuncts following anatomic reconstruction to optimize stability.<br /><br />Outcomes vary by technique and defect severity, but correcting retroversion to within 10-15° is critical for durable results. Most glenoid deformities can be managed successfully with eccentric reaming, with advanced methods reserved for severe or complex cases. New technologies like CT navigation hold promise for improving implant positioning and long-term outcomes.

Keywords

Glenoid bone defects

Shoulder arthroplasty

Walch classification

Glenoid retroversion

Total shoulder arthroplasty failure

Preoperative CT 3D reconstruction

Eccentric reaming

Bone grafting

Augmented glenoid components

Reverse total shoulder arthroplasty