This critical analysis review covers how to evaluate and treat glenoid bone deficiency during total shoulder arthroplasty. It walks through normal glenoid anatomy, the Walch wear classification, imaging, and the principles of restoring neutral version. It then compares eccentric reaming, bone-grafting, augmented components, and reverse arthroplasty by the amount of correction each can achieve.
Start with the decision rule this review builds toward: match the correction technique to the amount of retroversion. For mild posterior wear up to about 15° of retroversion, eccentric reaming of the anterior high side is preferred. Beyond that, reaming medializes the joint and penetrates the narrowing vault, so bone-grafting or an augmented component becomes the better choice.
The why is biomechanical. A glenoid left in more than 10° of retroversion sees cement stress rise 326% and micromotion rise 706%, and over 15° drives peg osteolysis. That chain (posterior wear to retroversion to eccentric loading to loosening) is the core concept to carry into board questions and the operating room.
Know the Walch types cold, since they frame the entire treatment algorithm. For the elderly, low-demand patient with severe posterior subluxation, reverse arthroplasty is a reasonable primary answer that avoids staged reconstruction. One pitfall to remember: do not try to fix a retroverted glenoid by anteverting the humeral component, because it does not work.
This critical analysis review covers how to evaluate and treat glenoid bone deficiency during total shoulder arthroplasty. It walks through normal glenoid anatomy, the Walch wear classification, imaging, and the principles of restoring neutral version. It then compares eccentric reaming, bone-grafting, augmented components, and reverse arthroplasty by the amount of correction each can achieve.
Start with the decision rule this review builds toward: match the correction technique to the amount of retroversion. For mild posterior wear up to about 15° of retroversion, eccentric reaming of the anterior high side is preferred. Beyond that, reaming medializes the joint and penetrates the narrowing vault, so bone-grafting or an augmented component becomes the better choice.
The why is biomechanical. A glenoid left in more than 10° of retroversion sees cement stress rise 326% and micromotion rise 706%, and over 15° drives peg osteolysis. That chain (posterior wear to retroversion to eccentric loading to loosening) is the core concept to carry into board questions and the operating room.
Know the Walch types cold, since they frame the entire treatment algorithm. For the elderly, low-demand patient with severe posterior subluxation, reverse arthroplasty is a reasonable primary answer that avoids staged reconstruction. One pitfall to remember: do not try to fix a retroverted glenoid by anteverting the humeral component, because it does not work.