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Abstract
Glenoid wear is common in the setting of shoulder ar- thritis. Severe glenoid erosion presents a serious challenge to the surgeon performing a shoulder arthroplasty. This paper presents the various classification schemes for glenoid erosion. The results of the six main treatment options for shoulder arthroplasty with an eroded glenoid are reviewed. The six treatment options include: 1. eccentric reaming, 2. bone grafting, 3. use of inset glenoid, 4. use of an augmented (asymmetric) glenoid component, 5. hemiarthroplasty, and 6. reverse shoulder arthroplasty. A treatment algorithm is proposed based on the amount of glenoid erosion.
Severe glenoid wear resulting in the need for shoulder replacement surgery is a challenge; however, new tools for dealing with this complicated entity are rapidly evolving, including the use of augmented anatomic glenoid components and reverse shoulder arthroplasty with augmented baseplates.
Primary total shoulder arthroplasty has over time yielded excellent clinical results.1-3 Rates of shoulder arthroplasty have grown tremendously with 20,000 to 25,000 performed annually.4 This number continues to expand as well. The most common indications for shoulder arthroplasty are osteoarthritis or rheumatoid arthritis; how- ever, more recently indications have expanded to include certain fractures, arthritis associated with recurrent dislo- cations or trauma, metabolic diseases, tumors, and glenoid dysplasia.5,6 Survivorship has been reported to be approxi- mately 85% at 15 years7; however, the revision burden has been estimated to be 7%.8
Most complications of total shoulder arthroplasty involve glenoid component loosening.9-11 Factors affecting loosening of the component include changes in joint reaction forces from the normal state (rotator cuff failure), malposition of the implant, or insufficient glenoid bone stock to support the implant.7,8,12
Lack of sufficient glenoid bone stock from erosion or dysplasia is one of the most difficult problems shoulder arthroplasty surgeons face. Numerous studies have reported compromised results with total shoulder arthroplasty in the presence of significant posterior glenoid bone loss.13-15 Ian- notti and Norris13 found that, compared to other patients with shoulder arthroplasty in their study, patients with posterior subluxation of the humeral head and posterior glenoid ero- sion had lower final American Shoulder and Elbow Surgeons scores, increased pain, and decreased active external rota- tion. Levine and coworkers16 showed only 63% satisfactory results after hemiarthroplasty in patients with type II or posteriorly worn glenoids.