Review Question - QID 339

The patient is being considered for total shoulder arthroplasty, but the axial CT scan demonstrates significant glenoid retroversion and loss of glenoid bone stock. This patient is at risk for glenoid component failure because of significant bone loss. Not resurfacing the glenoid and performing a hemiarthroplasty is an option. If the glenoid is going to be re-surfaced as the question states, posterior glenoid bone grafting should be performed.

Steinmann et al reported on using the cut autologous humeral head to fashion a bone graft for the glenoid in 28 patients. While there was some component loosening, they found that the overall results were similar to other series of total shoulders. According to Hill et al, despite the finding that eight shoulders had an unsatisfactory functional result at the time of longterm follow-up, corticocancellous grafting of the glenoid successfully restored glenoid version and volume in fourteen of the seventeen shoulders in the present study. They noted that patients with glenoid deficiency often have associated glenohumeral instability, which may affect the results of total shoulder arthroplasty. Boyd et al did a retrospective review of their arthoplasties with and without the use of a glenoid component and found progressive glenoid loosening in 12% of total should arthroplasties but no correlation with pain relief or range of motion was noted.