Abstract
Background
As techniques and implants for reverse total shoulder arthroplasty (rTSA) evolve, a greater emphasis is being placed on preserving glenoid bone stock and optimizing shoulder biomechanics. Augmented baseplates preserve glenoid bone and improve shoulder range of motion by lateralizing the center of rotation of the glenosphere, while also reducing postoperative complications after rTSA. The technique for bone preservation with use of augmented baseplates in the absence of bone loss and the outcomes of a series of cases are contained in this report.
Materials and Methods
A retrospective chart review was conducted for 37 patients with Walch type A1/Sirveaux E0 glenoids who underwent primary rTSA using a bone preserving technique with an augmented baseplate between January 2018 and January 2019 at a single site by a single surgeon. The primary outcome measures were range of motion, strength, and patient-reported clinical outcomes (pain and function rated on a visual analog scale; single assessment numeric evaluation; American Shoulder and Elbow Surgeons score; and disabilities of the arm, shoulder, and hand score). Preoperative radiographs were analyzed for the presence of glenoid bone loss and postoperative radiographs were assessed for evidence of component loosening and scapular notching. A repeated measures design was used, and preoperative and postoperative comparisons were made using parametric t-tests.
Results
At an average follow-up of 23.3 ± 6.3 months, there was a significant improvement in active forward flexion and abduction and nonsignificant improvement in external rotation. There was no radiographic evidence of glenoid notching in any of the patients and optimal glenoid inclination was observed. Patient-reported outcome scores after an average of 25.2 ± 10.0 months indicated a significant improvement in pain, function, and scores for the American Shoulder and Elbow Surgeons and disabilities of the arm, shoulder, and hand assessments. There were no substantial postoperative radiographic findings, intra/postoperative complications, or revisions/reoperations.
Conclusion
rTSA with augmented baseplates for glenoid bone preservation in patients with minimal or no bone loss is effective for preserving glenoid bone stock and significantly improves the range of motion and patient-reported outcomes after approximately 2 years.
Keywords: Reverse total shoulder arthroplasty, Aaugmented baseplate, Glenoid preservation, Off-axis reaming, Scapular notching, Reverse shoulder arthroplasty angle
Reverse total shoulder arthroplasty (rTSA) corrects a variety of debilitating shoulder pathologies. Patients with rotator cuff arthropathy, glenohumeral arthritis with rotator cuff tear, proximal humeral fracture malunion, nonunion, or revision shoulder arthroplasty are candidates for an rTSA procedure. Since its adoption in the United States following approval in 2004, rTSA has become a widely used intervention.4 Prior short-term studies have shown favorable clinical outcomes with standard baseplates; however, 4.6%-33% of patients experienced complications at long-term follow-up.9,12,14,16,19,22 It was shown that large glenoid bone defects were associated with greater baseplate loosening.17
Baseplate superior inclination is a critical factor that contributes to early failure of rTSA. Correction of glenoid inclination to neutral or inferior tilt is essential for a successful outcome in rTSA. Historically, glenoid inclination in the anatomic shoulder has been reported using the beta angle.13,18 Glenoid inclination based on this method is variable. A study radiographically analyzing elderly patients with rotator cuff arthropathy demonstrated that the beta angle had a mean of 16° ± 6° of superior inclination on plain radiographs, 11° ± 5° on reformatted 2D computed tomography (CT) scans, and 12° ± 6° via three-dimensional CT reconstructive software.2 Recently, the beta angle has been shown to under-report the amount of inclination that requires correction in rTSA. The reverse shoulder arthroplasty (RSA) angle is the inclination over the inferior aspect of the glenoid where the glenoid baseplate is positioned in rTSA and accurately reports the extent of inclination that requires correction in rTSA.2 Comparison of the beta angle to the RSA angle demonstrates a mean difference of 10° ± 5°.2 Using the RSA angle, a minimum 20° ± 5° of inclination needs to be corrected in rTSA.
Inclination is typically corrected during rTSA by reaming the inferior aspect of the glenoid. Standard baseplates require eccentric reaming in most cases to remove a substantial amount of glenoid bone resulting in medialization of the center of rotation of the glenosphere. An unfortunate consequence of standard baseplates and eccentric reaming is excessive medialization, which shortens the remaining rotator cuff, reduces deltoid wrapping, and compromises glenoid bone quality,1,3,5,7,11,20,21 including the bone supporting the baseplates.1,3,5 To address these issues, augmented glenoid baseplates have been developed.
Compared to standard baseplates, augmented baseplates reduce the amount of glenoid bone removal by more than 50% in some cases, while correcting the angle of inclination and lateralizing the implant' s center of rotation for optimal biomechanics.5,24 Lateralization of the implant's center of rotation and correction of inclination decreases shear and torque forces on the baseplate, decreases scapular notching rates, decreases acromial stress fracture incidence, improves soft tissue tension, and increases impingement-free range of motion (ROM).9,11 In addition, augmented baseplates reduce the rates of complications and scapular notching compared to that with bone grafting of the glenoid during rTSA.22
Multiple clinical studies have reported good outcomes with the use of augmented baseplates in rTSA to address bone deficiency.5,9,12,14,16,22,24 This report describes a consecutive series of rTSA procedures with augmented baseplates for bone preservation in patients with minimal or no glenoid bone loss. Examining the preservation benefits of augmented baseplates in this population is important because it has been reported that more than half (53%) of patients with rotator cuff arthropathy have no glenoid erosion.15 This report describes the surgical technique of native glenoid preservation in rTSA and the mid-term clinical, radiographic, and patient-reported outcomes.
Methods
Patient population
This was a retrospective review of 42 patients with Walch type A1/ Sirveaux E0 glenoids, demonstrating minimal or no erosion, which underwent primary rTSA at one tertiary referral university hospital between January 2018 and January 2019. The operations were performed with the same technique by a single surgeon. Patients who underwent an rTSA procedure for primary osteoarthritis, rotator cuff arthropathy, humeral fracture, etc., in the specified time frame and completed a minimum of 12 months of clinical and radiographic follow-up were eligible for the study. Five patients were excluded from the study because they did not meet the inclusion criteria; thus, the data from 37 patients were included in the study.
Preoperative and postoperative data were collected from electronic medical records. The ethical committee of the participating institution waived the need for approval and the need to obtain consent for the collection, analysis, and publication of the retrospectively obtained and anonymized data for this noninterventional study.
Preoperative planning
Each patient's scapula was three-dimensionally reconstructed from CT scans, which displayed any significant osseus defects. The scapular plane was determined by selecting three points: the trigonum spinae, the inferior angle of the scapula, and the center of the glenoid vault. A software program uses this information to determine the glenoid version and inclination. A computer modeling system denotes the implant version, inclination, and sagittal plane roll from which the surgeon can optimize the placement (location and orientation) of the baseplate and glenosphere. We prefer to position the baseplate on the inferior aspect of the glenoid with neutral version and 5° of inferior tilt (Fig. 1). This position decreases the amount of eccentric reaming required, optimizes the biomechanical loading of the baseplate, and allows for overhang of the glenosphere below the inferior rim of the glenoid to prevent scapular notching. After the baseplate is positioned in the optimal location, the ream surface is set to 50%, replicating the first ream for the half wedge–augmented baseplate. Once the baseplate depth is set, the augment size can be increased until the baseplate is fully supported. The central screw length is determined to allow for bicortical purchase on the medial cortex of the glenoid. The screw typically exits into the subscapularis fossa on the anterior scapula. The glenosphere size is then selected as per the width of the glenoid so there is at least 2-3 mm of overhang anteriorly and posteriorly. The glenosphere inferior offset can then be dialed to create 2-3 mm of overhang of the glenosphere below the inferior rim of the glenoid to prevent scapular notching and allows for an impingement-free arc of motion of the humeral component. A patient-specific guide can be requested for improved accuracy and execution of the plan in the operating room. Alternatively, measurements can help identify the starting point and trajectory of the central pin.
Figure 1.
(A) 3D planning for rTSA in a patient without significant glenoid bone wear using a nonaugmented baseplate with reaming to correct inclination to 5° of inferior tilt, neutral version, and obtain full backside support for the implant. (B) 3D planning for same glenoid with an augmented baseplate demonstrating glenoid bone preservation and lateralization.
Surgical technique
Preoperative set-up and dissection
The patient is placed in the beach chair position and a standard deltopectoral incision is made to expose the glenohumeral joint. Humeral preparation is performed for a short stem implant with a humeral head cut at 30 degrees of retroversion and 135 degrees of inclination. Key steps for glenoid exposure include mobilization of the deltoid, complete capsular release from the humerus, low humeral head cut without compromise of any remaining rotator cuff, and removal of humeral osteophytes. After exposure of the glenoid, the labrum is excised and the capsule is released circumferentially around the glenoid. Once adequate exposure is obtained, glenoid implantation with the augmented baseplate is performed.
Glenoid preparation and placement of the augmented baseplate
The glenoid pin guide is placed at the lower 1/3 of the glenoid and the guide pin for the glenoid reamer is placed in neutral version and 5 degrees of inferior tilt. The glenoid is reamed to 50% baseplate contact over the inferior aspect of the glenoid to correct the inclination to the desired 5° of inferior tilt of the baseplate. Augment sizing guides are used to help determine the smallest implant that will allow for full seating over the superior aspect of the glenoid. It is important to remove any remaining cartilage from the glenoid to ensure sizing is performed on subchondral bone. Sizing starts with the small guide and progresses to the medium or large if needed. The augment alignment guide positioned in line with the 50% reamed surface and a pilot hole is drilled for the peg reference to control bone preparation and implant insertion. The appropriately sized off-axis augment reaming guide is then inserted using the peg reference for alignment and fixation is obtained with a 4.5-mm cancellous screw. The superior glenoid is then reamed to prepare for the appropriately sized augment and the reaming guide is removed. The final implant is positioned using the peg reference on the inserter to accurately align the position of the augment with the bone preparation. The peg reference is essential because it ensures that the baseplate is prepared and placed in the identical position. Just 5° of malrotation of the baseplate can decrease contact by more than 50%. The baseplate is impacted to full seating and the baseplate is fixed with a 6.5-mm central screw and 4 peripheral 4.75-mm locking screws. The appropriate glenosphere size and inferior offset are assembled as per the preoperative plan. The final glenosphere is impacted on to the baseplate.
Humeral tray trialing
The size and offset of the humeral tray and polyethylene liner are trialed and verified prior to impaction. Subsequently, the shoulder is reduced and incisions are closed.
Postoperative plan
One day after the procedure, patients begin a therapy program with pendulum exercises; passive ROM exercises of the shoulder; and active elbow, wrist, and hand exercises. The patient is given an immobilizer to wear during the first 6 weeks after surgery; the immobilizer can be removed for hygiene activities and light below-shoulder-level activity as pain allows. After 6 weeks, the immobilizer is discontinued and patients are allowed to use the arm for light daily activity. Full-weight-bearing activity is permitted at 3 months after surgery.
Outcomes
The primary outcome measures of this study were ROM, strength, and patient-reported clinical outcomes, including visual analog scale measures of pain and function; single assessment numeric evaluation scores; American Shoulder and Elbow Surgeons (ASES) scores; and disabilities of the arm, shoulder, and hand (QuickDASH) scores. Radiographic data were analyzed preoperatively (Fig. 2) to identify Walch classification and glenoid version/inclination and postoperatively (Fig. 3) for evidence of component loosening and scapular notching.
Figure 2.
Preoperative imaging of a 79-year-old patient who underwent augmented rTSA with a bone-preserving technique to repair primary osteoarthritis and rotator cuff arthropathy of the left shoulder. The patient had significant pain and a limited ROM with active forward elevation of 120° with a component of escape, external rotation to 45°, and internal rotation to lumbosacral junction. The patient had an E0 and A1 glenoid, as per Sirveaux and Walch classifications respectfully. (A) X-ray in the Grashey view of the leftleft shoulder. (B) Axillary X-ray of the leftleft shoulder. (C) Coronal CT of the glenohumeral joint. (D) Axillary CT of the glenohumeral joint.
Figure 3.
Postoperative anteroposterior X-ray of the same patient shown in Figure 2. The implantation included a centrally placed small augmented glenoid baseplate, a 25-mm central screw, 4 peripheral screws, 36-mm glenosphere with 1.5-mm inferior offset, a standard humeral tray, and 9 mm × 83 mm (mini) humeral stem. The glenoid and humeral components remained well fixed at follow-up.
Statistical analysis
Preoperative and postoperative clinical and radiographic data were compared. A repeated measures design was used and continuous variables were compared using parametric t-tests. Mean scores from patient-reported outcome measures before surgery and at follow-up were compared. A P value of .05 was considered significant. Statistical analyses were performed using Microsoft Excel.
Results
Table I reports the demographic information for the 37 patients included in this study. Preoperative and surgical characteristics are presented in Table II. Postoperative radiographs showed that all baseplates and humeral stems were well fixed with evidence of incomplete lucent lines at the humeral stem in 10 cases (Table III). There were no cases of bone loss or scapular notching identified and there were no postoperative complications reported.
Table I.
Groupwise demographics (n = 37).
| Characteristic | Value |
|---|---|
| Age (yr) (mean ± SD) | 76.78 ± 7.2 |
| Sex (%) | |
| Male | 28% |
| Female | 72% |
| BMI (in kgm-2) (mean ± SD) | 31.19 ± 7.3 |
| Tobacco use (n) | |
| Active smokers | 3 |
| Past smokers | 13 |
| No history | 21 |
| Alcohol use (n) | |
| No use | 19 |
| Rare/Social | 14 |
| Regular | 4 |
| Medical history (%) | |
| Cardiovascular disease | 74% |
| Hepatic disease | 5% |
| Primary osteoarthritis | 51% |
| Rotator cuff arthropathy | 35% |
| Proximal humerus fracture | 14% |
| Steroid injections | 33% |
| Prior surgery on operative shoulder | 36% |
BMI, body mass index.
Table II.
Preoperative and surgical characteristics.
| Characteristic | Value |
|---|---|
| Operative side (n) | |
| Right | 18 |
| Left | 19 |
| Walch classification (n) | |
| A1 | 37 |
| A2 | 0 |
| B1 | 0 |
| B2 | 0 |
| B3 | 0 |
| C | 0 |
| D | 0 |
| Glenoid version (mean ± SD) | −5° ± 4.5° |
| Glenoid inclination (mean ± SD) | 13° ± 0.9° |
| Baseplate size (n) | |
| Small | 33 |
| Medium | 4 |
| Augment location (n) | |
| Superior | 35 |
| Superoposterior | 2 |
| Intraoperative complications (n) | 0 |
Table III.
Follow-up radiological findings.∗
| Description | No. |
|---|---|
| Postoperative complications | 0 |
| Humeral stem status | |
| Well fixed, no lucent lines | 27 |
| Well fixed, lucent lines | 10 |
| Loose | 0 |
| Glenoid baseplate status | |
| Well fixed, no lucent line | 37 |
| Well fixed, lucent line | 0 |
| Loose | 0 |
| Scapular notching (Nerot) grade | |
| 0 | 37 |
| 1 (small notch) | 0 |
| 2 (condensation) | 0 |
| 3 (evolutive notch) | 0 |
Follow-up time (mean ± SD) was 23.3 ± 6.3 months.
Clinical outcomes are presented in Table IV. At an average follow-up of 23.3 ± 6.3 months, active forward flexion and abduction were significantly improved (P < .001) and there was evidence of nonsignificant improvement in external rotation. Notably, all patient-reported measures revealed improvements at 25.2 ± 10.0 months after the procedure, with significantly improved scores (P < .05) for shoulder pain and function and for QuickDASH and ASES assessments. There was a nonsignificant improvement in single assessment numeric evaluation score.
Table IV.
Clinical outcomes.
| Assessment | Patient-reported scores (mean ± SD) |
P value | |
|---|---|---|---|
| Preoperative | Postoperative∗ | ||
| Shoulder pain (VAS range 0-10) | 6.30 ± 1.6 | 2.09 ± 2.1∗ | <.001 |
| Shoulder function (VAS range 0-10) | 3.52 ± 2.2 | 5.75 ± 2.6∗ | .026 |
| QuickDASH | 58.79 ± 15.7 | 34.69 ± 24.4∗ | <.001 |
| SANE | 34.67 ± 24.9 | 49.69 ± 32.1∗ | .287 |
| ASES shoulder (surgery side) | 38.56 ± 17.6 | 71.23 ± 18.9∗ | <.001 |
| Active ROM | |||
| Forward flexion | 90 ± 35 | 150 ± 25† | <.001 |
| Abduction | 80 ± 35 | 145 ± 30† | <.001 |
| External rotation @ 0o | 30 ± 20 | 40 ± 15† | .240 |
| Muscle strength | |||
| Deltoid | 5 ± 0.3 | 5 ± 0.2† | .162 |
| Subscapularis | 5 ± 0.6 | 5 ± 0.6† | .810 |
| Biceps | 5 ± 0.0 | 5 ± 0.0† | >.999 |
| Triceps | 5 ± 0.0 | 5 ± 0.0† | >.999 |
SD, standard deviation; VAS, visual analog scale; QuickDASH, disabilities of the arm, shoulder, and hand; SANE, Single Assessment Numeric Evaluation; ASES, American Shoulder and Elbow Surgeons; ROM, range of motion.
Bold values represent each clinical outcome that had significant improvement from preop to postop.
Time since surgery (mean ± SD) was 25.2 ± 10.0 months.
Time since surgery (mean ± SD) was 23.3 ± 6.3 months.
Discussion
Augmented baseplates were developed to address glenoid bone deficiency that is frequently encountered during rTSA. It is now recognized that the augmented glenoid baseplates preserve bone stock in patients both with and without glenoid bone deficiency.23 In patients without bone wear, the augment allows for correction of glenoid inclination from superior to neutral or inferior with less bone removal than eccentric reaming.23 In this report, we describe our technique for the use of augmented baseplates for bone preservation in rTSA without significant glenoid bone wear. Our experience with augmented baseplates in rTSA supports the benefits of their use in all cases for bone preservation.
All patients in our study experienced statistically significant and clinically relevant improvements in pain, active ROM, and patient-reported outcomes at 2 years of follow-up. The outcomes in this study are similar to reported outcomes for primary rTSA in the literature. In a recent meta-analysis including 52 studies with more than 3000 patients, the mean ASES score at 2 years of follow-up was 79 points which is similar to the results in our study.6
Improvement in ROM is one of the clinical benefits of rTSA.8,10 In our study, active ROM improved to 150 degrees of forward elevation and 40 degrees of external rotation at final follow-up. These results compare favorably to a recent meta-analysis demonstrating forward elevation of 134 degrees and 36 degrees of external rotation.6 This improvement in ROM may be associated with the lateralized center of rotation that is obtained with the use of the augmented baseplate. Previous literature has reported improved biomechanics including a lateralization of the center of rotation following rTSA with augmented baseplates compared to nonaugmented baseplates.1,3,5,7,11,20,21 Lateralization of the center of rotation of the glenosphere results in improved deltoid wrapping and functionality. Lateralization using an augmented baseplate does not increase the torque and shear forces on the baseplate which is encountered when using a lateralized center of rotation glenosphere. This results in the benefits of lateralization without compromising baseplate stability.
Augments can be used to improve fixation and lateralize the center of rotation in rTSA. In biomechanical and CT-based studies, augmented baseplates remove less bone and cover a larger area of the glenoid fossa, thereby minimizing baseplate loosening, migration, and micromotion.17 Our results demonstrated no evidence of baseplate loosening, hardware failure, or radiolucency with the use of augmented baseplates in rTSA at final follow-up. These findings remain to be consistent with other studies demonstrating low complication rates with augmented baseplates and higher rates of complications with standard baseplates, bone grafting, and eccentric reaming in rTSA.5,9,12,14,16,22,24 In addition, there was no scapular notching observed on radiographs at final follow-up in our study. This is compared to 14% notching rate in the recent meta-analysis and >90% in historical cases with Gramont stye prostheses.6 Our results with augmented baseplates are consistent with other reports demonstrating decreased incidence of scapular notching in patients with augmented baseplates compared to patients who received standard baseplates, bone grafting, and eccentric reaming.1,3,5,7,8,10,11,22
This case series demonstrates significant improvements in active shoulder ROM and patient-reported outcomes at 2 years after rTSA with augmented baseplates using a bone-preserving technique in patients without significant glenoid bone wear. Despite the successful results, there are limitations of this study, including a small patient population, lack of a control group, and short-term follow-up. Future studies are needed to obtain more data from larger cohorts with longer-term follow-up to confirm the benefit of using augmented baseplates in all rTSA cases regardless of the presence of glenoid bone wear.
Conclusion
The use of augmented baseplates for bone preservation in patients without glenoid bone wear results in improved clinical and radiographic outcomes with no complications at short-term follow-up. The use of augmented baseplates and off-axis reaming in rTSA preserves glenoid bone stock and is a reliable and reproducible technique that yields significant improvements in ROM, patient-reported outcomes, and postoperative radiographic findings.
Disclaimers:
Funding: No funding was disclosed by the authors.Conflicts of interest: Thomas R. Duquin receives royalties, consulting fees, and research support from Zimmer-Biomet. John W. Sperling receives royalties from Zimmer-Biomet. The other authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Given his role as Co-Editor-in-Chief of this publication, Dr. John Sperling had no involvement in the peer-review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Dr. Ed Craig.
Footnotes
Institutional review board approval was not required for this technique article.
References
- 1.Allred J.J., Flores-Hernandez C., Hoenecke H.R., Jr., D’Lima D.D. Posterior augmented glenoid implants require less bone removal and generate lower stresses: a finite element analysis. J Shoulder Elbow Surg. 2016;25:823–830. doi: 10.1016/j.jse.2015.10.003. [DOI] [PubMed] [Google Scholar]
- 2.Boileau P., Gauci M.O., Wagner E.R., Clowez G., Chaoui J., Chelli M., et al. The reverse shoulder arthroplasty angle: a new measurement of glenoid inclination for reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2019;28:1281–1290. doi: 10.1016/j.jse.2018.11.074. [DOI] [PubMed] [Google Scholar]
- 3.Clavert P., Millett P.J., Warner J.J. Glenoid resurfacing: what are the limits to asymmetric reaming for posterior erosion? J Shoulder Elbow Surg. 2007;16:843–848. doi: 10.1016/j.jse.2007.03.015. [DOI] [PubMed] [Google Scholar]
- 4.Familiari F., Rojas J., Nedim Doral M., Huri G., McFarland E.G. Reverse total shoulder arthroplasty. EFORT Open Rev. 2018;3:58–69. doi: 10.1302/2058-5241.3.170044. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Friedman R., Stroud N., Glattke K., Flurin P.H., Wright T.W., Zuckerman J.D., et al. The impact of posterior wear on reverse shoulder glenoid fixation. Bull Hosp Jt Dis (2013) 2015;73:S15–S20. [PubMed] [Google Scholar]
- 6.Galvin J.W., Kim R., Ment A., Durso J., Joslin P., Lemos J.L., et al. Outcomes and complications of primary reverse shoulder arthroplasty with minimum of 2 years' follow-up: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31:e534–e544. doi: 10.1016/j.jse.2022.06.005. [DOI] [PubMed] [Google Scholar]
- 7.Gillespie R., Lyons R., Lazarus M. Eccentric reaming in total shoulder arthroplasty: a cadaveric study. Orthopedics. 2009;32:21. doi: 10.3928/01477447-20090101-07. [DOI] [PubMed] [Google Scholar]
- 8.Glenday J., Kontaxis A., Roche S., Sivarasu S. Effect of humeral tray placement on impingement-free range of motion and muscle moment arms in reverse shoulder arthroplasty. Clin Biomech (Bristol, Avon) 2019;62:136–143. doi: 10.1016/j.clinbiomech.2019.02.002. [DOI] [PubMed] [Google Scholar]
- 9.Gulotta L.V., Grey S.G., Flurin P.-H., Wright T.W., Zuckerman J.D., Roche C.P. Clinical outcomes of augmented rTSA glenoid baseplates. J Shoulder Elbow Surg. 2020;29:e168–e169. doi: 10.1016/j.jse.2020.01.055. [DOI] [Google Scholar]
- 10.Hasan S.S., Levy J.C., Leitze Z.R., Kumar A.G., Harter G.D., Krupp R.J. Reverse Shoulder prosthesis with a lateralized glenosphere: early results of a prospective multicenter study stratified by diagnosis. J Shoulder Elbow Arthroplasty. 2019;3 doi: 10.1177/2471549219844040. [DOI] [Google Scholar]
- 11.Hermida J.C., Flores-Hernandez C., Hoenecke H.R., D’Lima D.D. Augmented wedge-shaped glenoid component for the correction of glenoid retroversion: a finite element analysis. J Shoulder Elbow Surg. 2014;23:347–354. doi: 10.1016/j.jse.2013.06.008. [DOI] [PubMed] [Google Scholar]
- 12.Ho J.C., Thakar O., Chan W.W., Nicholson T., Williams G.R., Namdari S. Early radiographic failure of reverse total shoulder arthroplasty with structural bone graft for glenoid bone loss. J Shoulder Elbow Surg. 2020;29:550–560. doi: 10.1016/j.jse.2019.07.035. [DOI] [PubMed] [Google Scholar]
- 13.Hughes R.E., Bryant C.R., Hall J.M., Wening J., Huston L.J., Kuhn J.E., et al. Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res. 2003:86–91. doi: 10.1097/00003086-200302000-00016. [DOI] [PubMed] [Google Scholar]
- 14.Jones R.B., Wright T.W., Roche C.P. Bone grafting the glenoid versus use of augmented glenoid baseplates with reverse shoulder arthroplasty. Bull Hosp Jt Dis (2013) 2015;73:S129–S135. [PubMed] [Google Scholar]
- 15.Lévigne C., Garret J., Boileau P., Alami G., Favard L., Walch G. Scapular notching in reverse shoulder arthroplasty: is it important to avoid it and how? Clin Orthop Relat Res. 2011;469:2512–2520. doi: 10.1007/s11999-010-1695-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Lopiz Y., García-Fernández C., Arriaza A., Rizo B., Marcelo H., Marco F. Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26:1581–1588. doi: 10.1016/j.jse.2017.01.017. [DOI] [PubMed] [Google Scholar]
- 17.Martin E.J., Duquin T.R., Ehrensberger M.T. Reverse total shoulder glenoid baseplate stability with superior glenoid bone loss. J Shoulder Elbow Surg. 2017;26:1748–1755. doi: 10.1016/j.jse.2017.04.020. [DOI] [PubMed] [Google Scholar]
- 18.Maurer A., Fucentese S.F., Pfirrmann C.W., Wirth S.H., Djahangiri A., Jost B., et al. Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder. J Shoulder Elbow Surg. 2012;21:1096–1103. doi: 10.1016/j.jse.2011.07.010. [DOI] [PubMed] [Google Scholar]
- 19.Nam D., Kepler C.K., Neviaser A.S., Jones K.J., Wright T.M., Craig E.V., et al. Reverse total shoulder arthroplasty: current concepts, results, and component wear analysis. J Bone Joint Surg Am. 2010;92:23–35. doi: 10.2106/jbjs.J.00769. [DOI] [PubMed] [Google Scholar]
- 20.Roche C.P., Diep P., Grey S.G., Flurin P.H. Biomechanical impact of posterior glenoid wear on anatomic total shoulder arthroplasty. Bull Hosp Jt Dis. 2013;71:S5–S11. [PubMed] [Google Scholar]
- 21.Roche C.P., Diep P., Hamilton M.A., Wright T.W., Flurin P.H., Zuckerman J.D., et al. Impact of posterior wear on muscle length with reverse shoulder arthroplasty. Bull Hosp Jt Dis (2013) 2015;73:S63–S67. [PubMed] [Google Scholar]
- 22.Roche C., Flurin P.H., Grey S., Wright T., Zucherman J., Jones R. Clinical outcome comparison of augmented glenoid components vs glenoid bone grafting with reverse total shoulder arthroplasty. Orthop Proc. 2016;98-B:9. doi: 10.1302/1358-992x.98bsupp_10.Ista2015-009. 9. [DOI] [Google Scholar]
- 23.Slowinski J.J., Bauer J.A., Feng L., Schoch N., Sperling J.W., Duquin T.R. CT-based 3D modeling of glenoid bone preservation with augmented baseplates. Semin Arthroplasty: JSES. 2022 doi: 10.1053/j.sart.2022.09.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Virk M., Yip M., Liuzza L., Abdelshahed M., Paoli A., Grey S., et al. Clinical and radiographic outcomes with a posteriorly augmented glenoid for Walch B2, B3, and C glenoids in reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2020;29:e196–e204. doi: 10.1016/j.jse.2019.09.031. [DOI] [PubMed] [Google Scholar]