This review covers management of the glenoid in anatomic total shoulder arthroplasty. It addresses glenoid anatomy, pathology, implant options, indications, and the mechanisms behind component loosening. It also examines alternatives for young, active patients where glenoid implantation is often avoided.
When you counsel a patient for TSA, glenoid loosening is the complication that defines long-term success. It accounts for about 24% of all TSA complications and is the reason implants and techniques keep evolving.
Understand the mental model: edge loading drives the rocking horse phenomenon, so anything that worsens eccentric loading (rotator cuff dysfunction, instability, retroversion, superior inclination) accelerates loosening. This is why an intact cuff and neutral version matter.
Remember the deformity threshold. Eccentric reaming to correct more than 15° of deformity fails over half the time because the tapered glenoid vault runs out of bone. In advanced posterior wear, consider augmented components, bone grafting, or a different implant rather than aggressive reaming.
For the young, active patient there is no perfect answer. Glenoid resurfacing risks loosening, but hemiarthroplasty leaves 60% dissatisfied at 15 years with a fourfold higher revision risk. Counsel these patients that future revision is likely.
This review covers management of the glenoid in anatomic total shoulder arthroplasty. It addresses glenoid anatomy, pathology, implant options, indications, and the mechanisms behind component loosening. It also examines alternatives for young, active patients where glenoid implantation is often avoided.
When you counsel a patient for TSA, glenoid loosening is the complication that defines long-term success. It accounts for about 24% of all TSA complications and is the reason implants and techniques keep evolving.
Understand the mental model: edge loading drives the rocking horse phenomenon, so anything that worsens eccentric loading (rotator cuff dysfunction, instability, retroversion, superior inclination) accelerates loosening. This is why an intact cuff and neutral version matter.
Remember the deformity threshold. Eccentric reaming to correct more than 15° of deformity fails over half the time because the tapered glenoid vault runs out of bone. In advanced posterior wear, consider augmented components, bone grafting, or a different implant rather than aggressive reaming.
For the young, active patient there is no perfect answer. Glenoid resurfacing risks loosening, but hemiarthroplasty leaves 60% dissatisfied at 15 years with a fourfold higher revision risk. Counsel these patients that future revision is likely.