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Posterior Glenoid Bone Grafting in Total Shoulder Arthroplasty for Osteoarthritis with Severe Posterior Glenoid Wear

·J Shoulder Elbow Surg·2017·56 citations·Shoulder & Elbow
DOI·PubMed
SummaryAbstract on PubMed →

This retrospective case series examines TSA with posterior glenoid bone grafting (PGBG) using humeral head autograft in 28 patients with glenohumeral osteoarthritis and severe posterior glenoid wear (retroversion −20° to −42°), asking whether this technique reliably corrects version and delivers durable clinical outcomes at minimum 2-year follow-up.

Study Snapshot

Design
Retrospective case series
Setting: Single center, Rush University Medical Center, Chicago
Funding: None
Objective
Whether posterior glenoid bone grafting corrects retroversion and improves outcomes in TSA
Outcome(s)
Glenoid retroversion correction on postoperative radiographs
Subjects
28 patients with severe posterior glenoid wear
  • TSA + humeral head autograft posterior glenoid bone grafting
Inclusion
  • Glenohumeral osteoarthritis with severe posterior glenoid wear
  • Intact rotator cuff
  • Retroversion requiring PGBG over eccentric reaming
Exclusion
  • Revision or reverse TSA
  • Non-osteoarthritis surgical indications
  • Missing radiographs or <2 years follow-up
Follow-up
Mean 4 years (range 2–10.5)
Statistics
Paired Student t-testDescriptive statistics

Key Findings

  • PGBG corrected mean glenoid retroversion from −28° to −4° (P < .001) — a clinically meaningful correction that eccentric anterior reaming cannot safely achieve at this magnitude
  • Posterior humeral head subluxation improved on both the scapular axis (87° → 60°) and midglenoid face (69° → 49°), both P < .001
  • 100% radiographic graft incorporation at mean 4-year follow-up; zero component revisions required
  • ASES score improved from 39 to 90 and VAS pain from 5 to 1 (both P < .001), with significant gains in forward flexion (89° → 149°), internal rotation, and external rotation
  • 10.7% of patients had broken or displaced fixation screws and 10.7% had broken center peg metal markers — all radiographic findings, largely asymptomatic, none requiring revision

Clinical Relevance

When you encounter a Walch B2 (or severe B1) glenoid with retroversion beyond ~15°–20° where eccentric anterior reaming would sacrifice excessive bone stock or risk vault penetration, PGBG with humeral head autograft is a reproducible alternative: the concave-convex match between the worn glenoid and resected humeral head creates a near-perfect interface, and this series shows reliable incorporation with durable version correction at 4 years.

Use an in-line keel or peg glenoid component — peripheral peg configurations are not compatible with this technique.

Related Articles

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Posterior Glenoid Bone Grafting in Total Shoulder Arthroplasty for Osteoarthritis with Severe Posterior Glenoid Wear

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|

Posterior Glenoid Bone Grafting in Total Shoulder Arthroplasty for Osteoarthritis with Severe Posterior Glenoid Wear

·J Shoulder Elbow Surg·2017·56 citations·Shoulder & Elbow
DOI·PubMed
SummaryAbstract on PubMed →

This retrospective case series examines TSA with posterior glenoid bone grafting (PGBG) using humeral head autograft in 28 patients with glenohumeral osteoarthritis and severe posterior glenoid wear (retroversion −20° to −42°), asking whether this technique reliably corrects version and delivers durable clinical outcomes at minimum 2-year follow-up.

Study Snapshot

Design
Retrospective case series
Setting: Single center, Rush University Medical Center, Chicago
Funding: None
Objective
Whether posterior glenoid bone grafting corrects retroversion and improves outcomes in TSA
Outcome(s)
Glenoid retroversion correction on postoperative radiographs
Subjects
28 patients with severe posterior glenoid wear
  • TSA + humeral head autograft posterior glenoid bone grafting
Inclusion
  • Glenohumeral osteoarthritis with severe posterior glenoid wear
  • Intact rotator cuff
  • Retroversion requiring PGBG over eccentric reaming
Exclusion
  • Revision or reverse TSA
  • Non-osteoarthritis surgical indications
  • Missing radiographs or <2 years follow-up
Follow-up
Mean 4 years (range 2–10.5)
Statistics
Paired Student t-testDescriptive statistics

Key Findings

  • PGBG corrected mean glenoid retroversion from −28° to −4° (P < .001) — a clinically meaningful correction that eccentric anterior reaming cannot safely achieve at this magnitude
  • Posterior humeral head subluxation improved on both the scapular axis (87° → 60°) and midglenoid face (69° → 49°), both P < .001
  • 100% radiographic graft incorporation at mean 4-year follow-up; zero component revisions required
  • ASES score improved from 39 to 90 and VAS pain from 5 to 1 (both P < .001), with significant gains in forward flexion (89° → 149°), internal rotation, and external rotation
  • 10.7% of patients had broken or displaced fixation screws and 10.7% had broken center peg metal markers — all radiographic findings, largely asymptomatic, none requiring revision

Clinical Relevance

When you encounter a Walch B2 (or severe B1) glenoid with retroversion beyond ~15°–20° where eccentric anterior reaming would sacrifice excessive bone stock or risk vault penetration, PGBG with humeral head autograft is a reproducible alternative: the concave-convex match between the worn glenoid and resected humeral head creates a near-perfect interface, and this series shows reliable incorporation with durable version correction at 4 years.

Use an in-line keel or peg glenoid component — peripheral peg configurations are not compatible with this technique.

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