Glenoid morphology in reverse shoulder arthroplasty: Classification and surgical implications

Background

A great challenge in reverse shoulder arthroplasty is the wide variation in glenoid morphology that adds uncertainties in glenoid component placement. The purpose of this study was to classify glenoid morphology and examining its effect on possible glenoid component fixation.

Materials and methods

The morphology of 216 glenoids was classified into normal and abnormal with subgroups defined by erosion sites. Six anatomic and 2 surgical parameters were compared among the classified groups. Plain radiographs or 2-dimensional (2D) computed tomography (CT) scans showed 62.5% of glenoids were normal and 37.5% were abnormal, with further subclassification of abnormal in posterior (17.6%), superior (9.3%), global (6.5%), and anterior (4.2%) erosions using 3D CT models.

Results

The standard centerline became significantly shorter in abnormal (19.6 ± 9.1 mm) than in normal (28.6 ± 4.1 mm, P < .0001) glenoids. Alternatively, the spine centerline provided longer bony distance in abnormal glenoids (34.9 ± 17.0 mm). Abnormal glenoid morphology also reduced peripheral screw placement area by 42% and limited it to the anterior and inferior quadrants.

Discussion

Glenoid morphology of the rotator cuff deficient shoulder can be reliably classified using this classification system consisting of normal and abnormal, which included 4 subgroups of posterior, superior, global, and anterior erosions.

Conclusions

Abnormal glenoid morphology was shown to have a significant effect on anatomical and surgical factors which can necessitate adjustments in surgical technique for reverse shoulder arthroplasty.

Level of evidence

Basic Science Study.

Keywords: Reverse shoulder arthroplasty, glenoid morphology, glenoid component placement