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Technique for Reverse Total Shoulder Arthroplasty for Primary Glenohumeral Osteoarthritis with a Biconcave Glenoid
Mena Mesiha, MD; Pascal Boileau, MD; Gilles Walch, MD

Overview

Introduction Our technique to treat a biconcave glenoid (severe B2 subtype) with reverse total shoulder arthroplasty corrects the humeral head subluxation and associated posterior glenoid bone loss, both of which are difficult to address with a conventional anatomic arthroplasty procedure.

Step 1: Preoperative Planning Obtain a preoperative computed tomography (CT) scan and make a detailed preoperative plan for reaming and bone-grafting.

Step 2: Surgical Approach Perform a standard deltopectoral approach.

Step 3: Humeral Preparation Prepare the humerus in a way that allows you to retain the humeral head for bone-grafting, being careful not to make an overly conservative first cut that effectively splits the intended bone graft.

Step 4: Glenoid Exposure Proper glenoid exposure is an essential element of this operation and even more difficult for the B2 glenoid than in a standard total shoulder replacement.

Step 5: Glenoid Preparation Having adequately visualized the glenoid, ream the anterior aspect of the glenoid in a way that executes your preoperative plan; do not ream >1 cm.

Step 6: Glenoid Fixation Use the screws to compress the bone graft between the metaglene and the native glenoid.

Step 7: Closure Proceed with your standard closure.

Results We presented our results of this procedure in twenty-seven shoulders in twenty-seven patients with a mean duration of follow-up of fifty-four months (range, twenty-four to 139 months).

Indications

Contraindications

Pitfalls & Challenges

Introduction

Our technique to treat a biconcave glenoid (severe B2 subtype [Fig. 1]) with reverse total shoulder arthroplasty corrects the humeral head subluxation and associated posterior glenoid bone loss, both of which are difficult to address with a conventional anatomic arthroplasty procedure1-10.

Fig. 1

Glenoid classification.

Multiple authors have found unsatisfactory results with conventional total shoulder replacement in this setting1-9. Most recently, one of us (G.W.) and colleagues …


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