Neer and Morrison reviewed 463 consecutive total shoulder arthroplasties (1973–1985) to determine how often glenoid bone loss truly prevents component implantation. They also report outcomes of large, internally fixed corticocancellous bone grafts used to reconstruct severely deficient glenoids.
Glenoid bone loss was widely cited as a contraindication to unconstrained TSA — the assumption being that a deficient glenoid simply could not accept a component. Neer's series showed that assumption was rarely correct: only 2 of 463 shoulders were truly unreconstructable.
When you encounter severe posterior glenoid erosion in TSA planning, the decision hierarchy the authors establish is: adjust component version first, level the high side second, and bone graft only when those measures fail. Cement to fill the gap is never an option.
Graft material comes from the resected humeral head. Autogenous, immediately available, no donor morbidity. When screw fixation is not possible due to defect geometry, a keystone graft wedged into the defect and stabilized by the cemented component is a valid alternative.
Broken fixation screws are a known radiographic finding in this technique and do not predict component failure or require reoperation. All three affected patients in this series had excellent outcomes.
Neer and Morrison reviewed 463 consecutive total shoulder arthroplasties (1973–1985) to determine how often glenoid bone loss truly prevents component implantation. They also report outcomes of large, internally fixed corticocancellous bone grafts used to reconstruct severely deficient glenoids.
Glenoid bone loss was widely cited as a contraindication to unconstrained TSA — the assumption being that a deficient glenoid simply could not accept a component. Neer's series showed that assumption was rarely correct: only 2 of 463 shoulders were truly unreconstructable.
When you encounter severe posterior glenoid erosion in TSA planning, the decision hierarchy the authors establish is: adjust component version first, level the high side second, and bone graft only when those measures fail. Cement to fill the gap is never an option.
Graft material comes from the resected humeral head. Autogenous, immediately available, no donor morbidity. When screw fixation is not possible due to defect geometry, a keystone graft wedged into the defect and stabilized by the cemented component is a valid alternative.
Broken fixation screws are a known radiographic finding in this technique and do not predict component failure or require reoperation. All three affected patients in this series had excellent outcomes.