AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-El componente glenoideo_ aspectos del diseño e implantación-Joaquin Sánchez-Sotelo, MD, PhD

El componente glenoideo_ aspectos del diseño e implantación-Joaquin Sánchez-Sotelo, MD, PhD

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The 2019 AANA/ASES Advanced Shoulder Surgery Course presentation by Dr. Joaquin Sanchez-Sotelo from Mayo Clinic Rochester focuses on the anatomical glenoid component in shoulder arthroplasty. Glenoid component loosening remains a leading cause of failure and revision surgery in anatomic shoulder replacements. Although metal-backed, uncemented components have been tried, excessive polyethylene wear has limited their success. Currently, cemented polyethylene and some hybrid components are standards, with expected survival improvements owing to advances in design, materials, surgical techniques, and selective use of reverse prostheses in severe cases (e.g., subluxation, bone loss).<br /><br />Surgeons aim to position the glenoid component at 0 to 10 degrees of retroversion with slight inferior tilt. Implantation goals include maximizing bone-implant contact (ideally near 100%), correcting bony defects with grafts or augmented components when necessary, avoiding radiolucent lines postoperatively, reproducing curvature mismatch between the glenoid component and humeral head, and preserving the subchondral bone to prevent implant subsidence.<br /><br />Glenoid preparation involves precise reaming aided by cannulated reamers, patient-specific guides, navigation, and future technologies like augmented reality and robotics. Enough bone must be removed to ensure stable implant-bone contact (~50%) without compromising subchondral bone. Precise preparation of fixation keel or pegs is critical, and trial components confirm stability and fit.<br /><br />During implantation, proper cementing techniques reduce radiolucent lines. Antibiotics and methylene blue may be added to acrylic cement. Measures to improve cement pressurization include component choice, high-pressure irrigation, manual/instrumented pressurization, suction devices, relative hypotension, and tranexamic acid use.<br /><br />Finally, selecting an appropriately sized humeral head with a slightly smaller curvature radius than the glenoid component, combined with balanced soft tissues, prevents eccentric positioning and edge loading that may cause glenoid loosening.

Keywords

shoulder arthroplasty

glenoid component

component loosening

polyethylene wear

cemented polyethylene

hybrid components

implant positioning

bone-implant contact

glenoid preparation

cementing techniques