Glenoid bony morphology of osteoarthritis prior to shoulder arthroplasty: what the surgeon wants to know and why
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REVIEW ARTICLE
Glenoid bony morphology of osteoarthritis prior to shoulder arthroplasty: what the surgeon wants to know and why Lawrence Lo 1 & Scott Koenig 2 & Natalie L. Leong 2,3 & Brian B. Shiu 2 & S. Ashfaq Hasan 2,4 & Mohit N. Gilotra 2,5 & Kenneth C. Wang 1,6 Received: 26 May 2020 / Revised: 7 October 2020 / Accepted: 7 October 2020 # This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract Shoulder arthroplasty is performed with increasing frequency, and osteoarthritis is the most common indication for this procedure. However, the glenoid side of the joint is widely recognized as a limiting factor in the long-term durability of shoulder replacement, and osteoarthritis leads to characteristic bony changes at the glenoid which can exacerbate this challenge by reducing the already limited glenoid bone stock, by altering biomechanics, and by interfering with operative exposure. This article reviews the Walch classification system for glenoid morphology. Several typical findings of osteoarthritis at the glenoid are discussed including central bone loss, posterior bone loss, retroversion, biconcavity, inclination, osteophyte formation, subchondral bone quality, and bone density. The three primary types of shoulder arthroplasty are reviewed, along with several techniques for addressing glenoid deformity, including eccentric reaming, bone grafting, and the use of augmented glenoid components. Ultimately, a primary objective at shoulder arthroplasty is to correct glenoid deformity while preserving bone stock, which depends critically on characterizing the glenoid at pre-operative imaging. Understanding the surgical techniques and the implications of glenoid morphology on surgical decision-making enables the radiologist to provide the morphologic information needed by the surgeon. Keywords Shoulder arthroplasty . Osteoarthritis . Glenoid . Component loosening . Surgical techniques
Introduction
* Kenneth C. Wang [email protected] 1
Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD 21201, USA
2
Department of Orthopaedics, University of Maryland, School of Medicine, 22 S. Greene St, Baltimore, MD 21201, USA
3
Department of Orthopaedics, University of Maryland, School of Medicine, 110 S. Paca Street, 6th Floor, Baltimore, MD 21201, USA
4
Department of Orthopaedics, University of Maryland, School of Medicine, 2200 Kernan Drive, Suite 1154, Baltimore, MD 21207, USA
5
Department of Orthopaedics, University of Maryland, School of Medicine, 100 Penn Street, Room 540D, Baltimore, MD 21201, USA
6
Imaging Service, Baltimore VA Medical Center, 10 N. Greene St, Rm. C1-24, Baltimore, MD 21201, USA
The number of shoulder arthroplasties performed in the United States over the past decade has sharply increased with one nationwide study reporting a 24% increase from 2011–2014 alone [1]. Although there are many indications for shoulder replacement surgery, osteoarthriti
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