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Age > 65
2%
18/792
Use of pegged glenoid component
3%
22/792
Glenoid morphology
80%
633/792
Rotator cuff atrophy
10%
79/792
Use of curved back glenoid component
4%
30/792
Select Answer to see Preferred Response
One of the most common and feared complications after anatomic total shoulder arthroplasty (aTSA) is glenoid loosening, which is more likely if performed in the setting of significant glenoid retroversion and biconcavity. aTSA is a reliable tool to treat glenohumeral arthritis, with a consistent improvement in pain and function noted in most cases. Studies have shown 10-year survival rates to be >90%. However, glenoid loosening can be problematic and become a source of pain for patients. In patients with Walch B2 glenoid morphology and significant retroversion, a higher risk of glenoid loosening has been demonstrated. Excessive medialization of the glenoid with eccentric reaming in order to correct this deformity is also not advised, as you may lose bone stock and affect glenohumeral joint mechanics. In these cases, possible solutions include the use of augments, bone graft or the use of reverse total shoulder arthroplasty (rTSA), given it's versatility and glenoid fixation options. It is also important to understand the types of glenoid implants in aTSA, as flat-backed, curved or inset glenoid components can be used. Wiater et al. published an overview of the glenoid component used in aTSA. They discuss the problems associated with loosening and go over different implants and surgical techniques that have been explored to improve this problem. They note that excessive medialization should be avoided and caution is necessary in glenoids with significant deformity and preoperative retroversion. Greiner et al. explored the incidence of radiolucent lines around cemented, pegged glenoid components based on glenoid morphology. They noted that there was a significantly higher rate of radiolucency in B2 and C type glenoids than in types A1, A2, and B1. Interestingly, they were unable to correlate these radiolucencies with poorer clinical outcomes. Incorrect Answers: Answer 1: Older age has not demonstrated an association with glenoid loosening. Answer 2: Both pegged and keeled glenoid components can be used, with some studies demonstrating no differences in loosening rates and some studies suggesting a higher rate in keeled components. Answer 4: Rotator cuff atrophy, defined by the Goutallier classification, has not been correlated with glenoid loosening. Answer 5: Curved backed glenoid components have been linked to a lower rate of loosening than flat backed glenoids in some studies.
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