This review addresses how to evaluate and manage glenoid bone loss and retroversion during primary total shoulder arthroplasty for osteoarthritis. It frames the problem around the Walch classification of glenoid morphology. It lays out when to ream, when to bone graft, when to augment, and when to leave version alone.
The decision tree in primary TSA runs off two numbers: degree of retroversion and amount of bone loss. Minor version changes correct with eccentric reaming to neutral. Once retroversion hits 15° or bone loss exceeds roughly 10 to 15 mm on axial CT, reaming alone removes too much anterior bone and risks vault penetration, so bone grafting or an augmented component enters the picture.
The biomechanics justify the effort: retroversion beyond 10° drives large increases in cement-bone micromotion, and malversion was present in 46% of failed but no successful TSAs.
The key pitfall to avoid is treating the dysplastic (type C) glenoid like a biconcave (type B2) one. In type C the humeral head stays centered in the retroverted socket, so forcing version correction overtensions the posterior capsule and steals internal rotation.
Remember the imaging trap too: the axillary view overestimates retroversion in up to 86% of patients, so get a CT before committing to a plan.
This review addresses how to evaluate and manage glenoid bone loss and retroversion during primary total shoulder arthroplasty for osteoarthritis. It frames the problem around the Walch classification of glenoid morphology. It lays out when to ream, when to bone graft, when to augment, and when to leave version alone.
The decision tree in primary TSA runs off two numbers: degree of retroversion and amount of bone loss. Minor version changes correct with eccentric reaming to neutral. Once retroversion hits 15° or bone loss exceeds roughly 10 to 15 mm on axial CT, reaming alone removes too much anterior bone and risks vault penetration, so bone grafting or an augmented component enters the picture.
The biomechanics justify the effort: retroversion beyond 10° drives large increases in cement-bone micromotion, and malversion was present in 46% of failed but no successful TSAs.
The key pitfall to avoid is treating the dysplastic (type C) glenoid like a biconcave (type B2) one. In type C the humeral head stays centered in the retroverted socket, so forcing version correction overtensions the posterior capsule and steals internal rotation.
Remember the imaging trap too: the axillary view overestimates retroversion in up to 86% of patients, so get a CT before committing to a plan.