This narrative review examines whether glenoid retroversion, posterior subluxation, and superior inclination need to be corrected during shoulder arthroplasty. It synthesizes clinical and biomechanical evidence across anatomic (aTSA) and reverse (rTSA) shoulder replacement. The central question: is routine version correction actually necessary?
The practical rule: stop chasing anatomic version and start prioritizing complete component seating and soft-tissue balance.
A retroverted glenoid with a centered humeral head often outperforms a version-corrected glenoid with persistent subluxation. That distinction matters because correcting version does not guarantee correcting subluxation, and subluxation is the stronger predictor of edge loading and loosening.
When you plan a case, separate the two problems. Substantial retroversion with preserved kinematics can be managed with a fully seated anatomic implant. Severe retroversion (>30°) with contracture or severe posterior subluxation, or a neoglenoid under 50% of the glenoid surface, pushes you toward rTSA.
Recognize that superior inclination, not retroversion, is the parameter that actually drives loosening and rotator cuff strain in aTSA. Keep postoperative inclination at or below 10°. Finally, weigh the downside of overcorrection: aggressive reaming and grafting risk bone loss, graft resorption, and peg perforation, and augmented rTSA baseplates carry an 11.4% acromion stress fracture rate.
This narrative review examines whether glenoid retroversion, posterior subluxation, and superior inclination need to be corrected during shoulder arthroplasty. It synthesizes clinical and biomechanical evidence across anatomic (aTSA) and reverse (rTSA) shoulder replacement. The central question: is routine version correction actually necessary?
The practical rule: stop chasing anatomic version and start prioritizing complete component seating and soft-tissue balance.
A retroverted glenoid with a centered humeral head often outperforms a version-corrected glenoid with persistent subluxation. That distinction matters because correcting version does not guarantee correcting subluxation, and subluxation is the stronger predictor of edge loading and loosening.
When you plan a case, separate the two problems. Substantial retroversion with preserved kinematics can be managed with a fully seated anatomic implant. Severe retroversion (>30°) with contracture or severe posterior subluxation, or a neoglenoid under 50% of the glenoid surface, pushes you toward rTSA.
Recognize that superior inclination, not retroversion, is the parameter that actually drives loosening and rotator cuff strain in aTSA. Keep postoperative inclination at or below 10°. Finally, weigh the downside of overcorrection: aggressive reaming and grafting risk bone loss, graft resorption, and peg perforation, and augmented rTSA baseplates carry an 11.4% acromion stress fracture rate.