This retrospective cohort evaluated a posteriorly stepped augmented all-polyethylene glenoid component in anatomic total shoulder arthroplasty. All patients had primary osteoarthritis with B2 or B3 glenoid morphology and posterior bone loss. It asks whether the augment corrects retroversion and posterior subluxation, and which preoperative factors predict osteolysis and worse clinical scores.
When you see primary OA with a B2 or B3 glenoid, the core problem is posterior bone loss driving retroversion, joint-line medialization, and a posteriorly subluxed head.
The old fix, asymmetric anterior reaming, corrects version but medializes the joint line and sacrifices bone, which sets up later loosening. A posteriorly augmented component corrects version with minimal bone removal and restores the native joint line instead. This paper shows that approach recenters the head in 85% and gets 73% under 15° of retroversion, with 90% reaching a good PSS at 2 years.
The practical decision rule: preoperative joint-line medialization over 3.7 mm or posterior bone loss over 6.9 mm predicts center-peg osteolysis, and severe posterior subluxation plus teres minor fatty infiltration flags patients who may be better served by reverse TSA. Remember this is Level IV evidence with short follow-up, so the durability question versus reverse TSA remains unsettled.
Disclosure to weigh: the senior author holds the patent on the augmented glenoid component studied here — read the favorable outcomes with that financial interest in mind, and look for independent replication before treating this as settled.
This retrospective cohort evaluated a posteriorly stepped augmented all-polyethylene glenoid component in anatomic total shoulder arthroplasty. All patients had primary osteoarthritis with B2 or B3 glenoid morphology and posterior bone loss. It asks whether the augment corrects retroversion and posterior subluxation, and which preoperative factors predict osteolysis and worse clinical scores.
When you see primary OA with a B2 or B3 glenoid, the core problem is posterior bone loss driving retroversion, joint-line medialization, and a posteriorly subluxed head.
The old fix, asymmetric anterior reaming, corrects version but medializes the joint line and sacrifices bone, which sets up later loosening. A posteriorly augmented component corrects version with minimal bone removal and restores the native joint line instead. This paper shows that approach recenters the head in 85% and gets 73% under 15° of retroversion, with 90% reaching a good PSS at 2 years.
The practical decision rule: preoperative joint-line medialization over 3.7 mm or posterior bone loss over 6.9 mm predicts center-peg osteolysis, and severe posterior subluxation plus teres minor fatty infiltration flags patients who may be better served by reverse TSA. Remember this is Level IV evidence with short follow-up, so the durability question versus reverse TSA remains unsettled.
Disclosure to weigh: the senior author holds the patent on the augmented glenoid component studied here — read the favorable outcomes with that financial interest in mind, and look for independent replication before treating this as settled.