This 2025 JAAOS narrative review surveys the evolution of glenoid implant design in anatomic total shoulder arthroplasty from Neer's 1974 keeled cemented implant to contemporary options, asking which design innovations address the persistent problem of glenoid loosening and how surgeons should match implant type to patient anatomy.
When planning anatomic TSA, map glenoid morphology with 3D CT and the Walch classification before selecting an implant: Walch A glenoids tolerate pegged onlay, inset, or zoned conformity designs with minimal reaming; B2/B3 glenoids with >10°–15° retroversion favor posterior augmented or augmented inset implants to avoid subchondral violation; and C (dysplastic) glenoids often require accepting 20°–25° of native retroversion with a low-profile recessed implant rather than aggressive correction — understanding the rocking-horse failure mechanism tells you why malpositioning in any direction is the common thread across all loosening modes.
This 2025 JAAOS narrative review surveys the evolution of glenoid implant design in anatomic total shoulder arthroplasty from Neer's 1974 keeled cemented implant to contemporary options, asking which design innovations address the persistent problem of glenoid loosening and how surgeons should match implant type to patient anatomy.
When planning anatomic TSA, map glenoid morphology with 3D CT and the Walch classification before selecting an implant: Walch A glenoids tolerate pegged onlay, inset, or zoned conformity designs with minimal reaming; B2/B3 glenoids with >10°–15° retroversion favor posterior augmented or augmented inset implants to avoid subchondral violation; and C (dysplastic) glenoids often require accepting 20°–25° of native retroversion with a low-profile recessed implant rather than aggressive correction — understanding the rocking-horse failure mechanism tells you why malpositioning in any direction is the common thread across all loosening modes.