Glenoid bone loss in primary total shoulder arthroplasty: evaluation and management

Glenohumeral osteoarthritis is the most common reason for shoulder replacement. Total shoulder arthroplasty provides reliable pain relief and restoration of function, with implant survivorship reported at 85% at 15 years. Glenoid component wear and aseptic loosening are among the most common reasons for revision. Glenoid wear characteristics have been correlated with, among other things, the degree of anatomic glenoid version correction. Anatomic glenoid reconstruction is particularly challenging in the presence of glenoid bone deficiency. Walch classified glenoid morphology into five types: type A, centered, without posterior subluxation but with minor erosion (A1) or major erosion (A2); type B, posteriorly subluxated (B1) or posteriorly subluxated with posterior glenoid erosion (B2); and type C, excessive glenoid retroversion. The type A glenoid represents only 59% of patients; thus, the need to address glenoid deformity is common. Methods of correction include asymmetric reaming of the anterior glenoid, bone grafting of the posterior glenoid, and implanting a specialized glenoid component with posterior augmentation. In many cases of type C or hypoplastic glenoid, the humerus is concentrically reduced in the deficient glenoid and glenoid deformity may not need to be corrected. Severely hypoplastic glenoid may require the use of bone-sparing glenoid components or reverse total shoulder arthroplasty.