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Type E2 glenoid bone loss orientation and management with augmented implants.

Sejla Abdic1, Nikolas K Knowles2, Gilles Walch3

  • 1Department of Orthopaedics and Traumatology, Paracelsus Medical University, Salzburg, Austria; Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Hospital, London, ON, Canada.

Journal of Shoulder and Elbow Surgery
|February 17, 2020
PubMed
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This summary is machine-generated.

Type E2 glenoid bone loss averages 47° in the posterosuperior quadrant, correlating with rotator cuff fatty infiltration. Patient-matched baseplates minimize bone removal for managing this complex bone loss.

Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Radiology

Background:

  • Type E2 glenoid bone loss presents a significant challenge in shoulder arthroplasty.
  • Understanding the orientation and contributing factors of this bone loss is crucial for successful reconstruction.

Purpose of the Study:

  • To quantify the orientation of type E2 bone loss and its relationship with rotator cuff fatty infiltration.
  • To evaluate the effectiveness of different reverse baseplate designs in managing type E2 glenoids.

Main Methods:

  • Computed tomography (CT) scans of 40 patients with type E2 glenoids were analyzed for pathoanatomic features and erosion orientation.
  • Rotator cuff fatty infiltration grades were correlated with erosion orientation angles.
  • Virtual implantation of four baseplate designs (standard, half-wedge, full-wedge, patient-matched) was performed to assess bone removal and range of motion.
Keywords:
BIO-RSAE2Glenoidaugmented implantsbone losscuff tear arthropathyimplant designreverse shoulder arthroplasty

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Main Results:

  • The average type E2 erosion orientation was 47° from the superoinferior axis, located in the posterosuperior quadrant (10:30 position).
  • Patient-matched baseplates required significantly less bone removal (200 mm³) compared to full-wedge (1228 mm³), half-wedge (1763 mm³), and standard (4009 mm³) designs.
  • Increased subscapularis fatty infiltration (grade 3 to 4) correlated with a more superior erosion orientation (P < .001).

Conclusions:

  • Type E2 bone loss typically orients towards the 10:30 position in the posterosuperior glenoid.
  • Patient-matched glenoid augmentation minimizes bone removal for seating, followed by wedge and standard designs.
  • Implant selection significantly impacts predicted range of motion, highlighting the importance of tailored surgical planning.