Simulation of surgical glenoid resurfacing using three-dimensional computed tomography of the arthritic glenohumeral joint: The amount of glenoid retroversion that can be corrected

Hypothesis

The magnitude of glenoid retroversion that can be surgically corrected in total shoulder arthroplasty and still enable implantation of a glenoid component has not been established. We hypothesized that increased retroversion will require smaller glenoid components for successful implantation when the glenoid is surgically corrected and that correction beyond 20 degrees of retroversion is not feasible without peg penetration.

Methods

Using 3-dimensional models created from computed tomography of 19 patients with advanced shoulder osteoarthritis, we simulated glenoid resurfacing on varying degrees of retroverted, osteoarthritic glenoids using an in-line 3-peg glenoid component and asymmetric reaming to correct version.

Results

Glenoids with preoperative retroversion of less than 12° could always be implanted with 46-mm and 52-mm glenoid components at neutral version without vault violation. Conversely, glenoids with greater than 18° of preoperative retroversion could not be implanted at neutral version due to vault violation from the pegs. The average preoperative glenoid retroversion of patients in which a 46-mm glenoid was implanted at neutral version was 8.9° ± 6.4° compared with 19.0° ± 7.1° for those that could not be implanted at neutral (P = .005).

Discussion

Computer-aided surgical simulation shows that glenoid retroversion is a critical factor in determining successful glenoid implantation. Smaller sized glenoid components allow for greater version correction and less residual postsimulation retroversion when an in-line pegged component is used.

Level of evidence

Level 2.

Keywords: Shoulder arthritis, glenohumeral arthritis, glenoid wear, glenoid retroversion, total shoulder replacement, glenoid resurfacing, computer simulation