Bone Loss In Shoulder Arthroplasty Syllabus

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B2 Glenoid Bone Loss and
Shoulder Arthroplasty:
Bone Grafts and Augmented
Glenoid Components
Carl J. Basamania, MD, FACS
The PolyClinic and
Swedish Orthopaedic Institute
Seattle, Washington

Presenter Disclosure Information
B2 Glenoid Bone Loss and Shoulder Arthroplasty:
Bone Grafts and Augmented Glenoid Components
Carl J. Basamania, MD, FACS
Disclosure Information
The following relationships exist:
DePuy/Johnson and Johnson: Consultant, Royalties
Biomet: Consultant, Royalties
Sonoma Orthopaedics: Consultant, Royalties
Invuity: Consultant, Stock Options
BioPoly: Consultant, Stock Options
Nothing of value received for this presentation
No “off label” use of any products

Glenoid Bone Loss in Osteoarthritis
• OA is the most common indication for TSA
• At least 75% of patients have some
posterior bone loss resulting in increased
glenoid retroversion
• In patients with severe OA, mean glenoid
version of 11° retroversion (range 2°
anteversion to 32° retroversion)
• Freidman, et al, JBJS, 1997

1

General Rules
• Bone loss must be addressed
• Glenoid rim erosion encompassing greater
than 25% to 30% of the articular surface
requires grafting
• Correct glenoid retroversion to < 10
degrees
– ideally < 6 degrees

Options for Management of
Posterior Glenoid Bone Loss in OA
•
•
•
•

Ream the high side to correct version
Use a bone graft to correct version
Use a custom implant to correct version
Reverse total shoulder arthroplasty

Place the humeral component in anatomic version

Problems with Eccentric Reaming
• The maximum amount of
retroversion that can be
corrected with eccentric
reaming is 15 degrees
– Warner, et al, JSES,
2007;16:843–848

•
•
•
•

Medialization of joint line
Cuff weakness
Creates smaller glenoid
Can result in significant
head/glenoid mismatch

2

Bone Grafting
• Restores the
original glenoid
plane
• Malunion, nonunion, and
increased surgical
time
• 10 fold higher
failure rate than
normal TSA

Glenoid with Posterior
Erosion

Bone
Graft

Cuomo, F., Checroun, A. “Avoiding Pitfalls and Complications in Total
Shoulder Arthroplasty. Orthop Clin North Am. 1998; 518.

Severe Glenoid Erosion
Use of a Bone Graft
• Greater than 1
cm.
• Bone graft
– Humeral head
– Iliac crest graft

• Screw fixation
• Avoid cement
wedges

3

4

Bone loss with Reverse TSA
• Bone loss
– Glenoid
• Reaming
• Cancellous grafting

Use of a RTSA
• Problems:
– In my experience, most of the posterior
erosion cases are in active males
– What do you do with a younger (<70) male
with an intact rotator cuff who wants to remain
as active as possible?

5

Can you use an augmented
glenoid?

Augmented Glenoid
• No medialization
• No implant
undersizing
• No need to bone
graft
• Re-establishes
normal joint line
• Returns cuff to
normal tension

Glenoid with
Posterior Erosion

Design Rationale
• Addresses posterior glenoid
erosion
– Walch Type B2

• Same peg fixation design as the
Anchor Peg Glenoid
– Central fluted interference fit peg
– Two inferior pegs
– One superior peg

• Novel instrumentation
– Accurate placement, orientation,
and precise bone preparation

6

Design Rationale (cont.)
• Spherical anterior backside
• Conical posterior backside (13 degree
angle)
– Design effectively counteracts posterior
loading

13°

Optimal Augmented Design
• Question:
– Is there an
optimal design
that counteracts
or minimizes the
deforming forces
on the glenoid
component?
Iannotti, et al, JSES, 2013, 22, 1530-1536

Optimal Augmented Design
• The “stepped”
design was the
only design that
showed no
increase in lift off of
the component
compared to a
standard glenoid
Iannotti, et al, JSES, 2013, 22, 1530-1536

7

Size Range

+7mm

+5mm

+3mm

Amount of Possible Correction

Augmented glenoids allowed correction up to
27.9 degrees (±7.9 degrees) with no significant
medialization
Sabesan, et al, JSES, 2014, 23, 964-973

8

Surgical Technique

Glenoid Exposure
Walch B2

Anterior Reaming

9

Posterior Guide

Oscillating Rasp

Glenoid “Hoes”

10

Posterior Step

Peripheral Drill Holes

Final Implant

11

Case Example:
60 year old female

Posterior glenoid erosion

12

Thanks!

13

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HOW TO DEAL
WITH B2-B3 GLENOID ?

Vumedi Webinar Feb 17, 2015

Disclosure
- Royalties: TORNIER
- Equity: IMASCAP
- Board of the French
Orthopedic Society

J Arthroplasty 1999

1

2/16/2015

« This classification is not accurate & reliable »
(Scalise & Iannotti)

Pb with degree of retroversion

Type C (dysplasia) is > 25°
Type B2 (2ary erosion) can also be > 25°

B2 glenoid is the consequence of
1/ static posterior subluxation of the HH
2/ secondary erosion of the posterior part of the glenoid

Need to have the proof of
secondary posterior wear
• see the paleo glenoid
• subluxation of the HH
( degrees of retroversion is not part of the diagnostic: 15 to 60°…)

B2 and A2 are sometimes confused
if the paleo glenoid is absent
Paleo glenoid not always visible
• level of the cut
• osteophytes’ anterior reconstruction
• severe erosion and minimal subluxation

concentric or eccentric glenoid…

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2/16/2015

1/ level of the cut
may change the
glenoid shape

B2
Biconcave

Same patient at
2 ≠ levels

A2
Concentric

2/ osteophyte’s anterior reconstruction
Biconcave becomes concentric…

B1

B2

1995

1999

B2 1997

C

2013

Osteophyte’s anterior reconstruction
Eccentric glenoid becomes a concentric one !

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3/ Severe erosion – minimal subluxation
concentric glenoid but severe RV

Introduction of

B3 glenoid
- No paleo-glenoid (concentric glenoid,
no biconcavity)
- Glenoid erosion & retroversion > 15°
- Posterior subluxation of the HH > 70%

B3 Glenoid

HH subluxation > 70%
Retroversion > 15°
No paleo-glenoid
Concentric glenoid

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Types B2 - B3 How to address ?

B2 and anatomic TSA 1992-2007
92 cases - 77m f-up
(Eccentric reaming, bone graft, post capsulorraphy, hum antev.)

- 66.3% sastisfied or very satisf.
- 16.3 % Revisions
- 20.6% glenoid loosening
Intermed. glenoid RV > 27° = 50% complic

Sublux / scapula > 80% = 50% complic

Static posterior subluxation recurs
glenoid loosening (rocking horse )

13y
5y
Case 1

9y
Case 2

Case 3

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B2 and Reverse SA 1998-2009
27 cases – 54 m f-up
81% females
Mean age: 74.1 yo (66-82 )
17 dominant shoulders (63%)

Exclusion criteria
Rotator cuff tear (2 tendons or more), Cuff tear arthropathy, Post traumatic arthritis
Rheumatoid arthritis, Revision arthroplasty, previous surgery

Reverse Prosthesis ( 2 stages)

Structural bone graft (1 stage)

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Results
Preop.

Postop.

p value

4

14

< 0.0001

Activity

7.9

18.5

< 0.0001

Mobility

14.2

35.1

< 0.0001

Strength

4.5

8.7

< 0.0001

Total

30.6

76.3

< 0.0001

Pain

93 % Satisfied or very Satisfied, 7 % Disappointed

Results: Range of Motion
Preop.

Postop.

p value

AFE

89°

152°

< 0.0001

RE1 A

3°

27°

< 0.0001

Buttocks

T12

< 0.0001

IR

SSV 81.7%

Radiographic results
All the graft but one healed, no glenoid RLL
• Scapular notching: 10 cases (37%)
Grade 1: 6, Grade 2: 4, Grades 3 & 4: 0

• Humerus Radiolucent lines: 2 (8.3%)
Humerus zone 1: 1, zone 7: 1

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Current indications for Reverse
in B2-B3 glenoid
• Subluxation HH / scapula
> 80%
• Failure to implant correctly a PE glenoid
- Glenoid RetroVersion > 10°
- Glenoid reaming > ½ suchond bone surf
- Seating < 80%

Thank you !

8

2/16/2015

Tricortical Iliac Crest Bone Grafts
VuMedi Webinar:
Bone Loss in Shoulder Arthroplasty
February 17, 2015

Tom R. Norris MD

COI Disclosure
• Tom R. Norris, MD
Tornier, Inc.
Consultant, stock, royalties, designer, fellowship
support
Disclosure information on AAOS website and
updated 4x/y

Glenoid Bone Loss
• Salvaging a failed shoulder
arthroplasty with glenoid
bone loss is a technically
challenging procedure.
• Iliac crest can allow for
successful one stage
reconstruction of the
glenoid vault in cases of
massive glenoid bone loss.

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2/16/2015

Tricortial iliac crest bone graft for massive
glenoid bone loss during revision shoulder
arthroplasty 2yr follow up
Mark A. Schrumpf MD,
Tom R. Norris MD
ICSES 2013 Nagoya, Japan

Methods

• Database search was performed of a single surgeon’s case
log from ‘05-’10
• Patients who underwent reconstruction of the glenoid
vault in a single stage revision surgery were identified
• All patients were revised to a reverse shoulder prosthesis.
• Data was collected in a prospective fashion for ASES,
Constant, WOOS, SANE and patient satisfaction.

Reconstruction Technique
• Deltopectoral approach used to
retrieve all failed implants
• Recipient glenoid was freed of
any soft tissue while taking care
to protect bone stock
• Iliac crest was prepared in-situ
and baseplate implanted in graft
• Graft cut free of pelvis and fixed
to scapula with baseplate screws

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TICBG

Results
• 23 shoulders were treated in 21 patients
• Average clinical follow up of 27 months
• Patient had undergone an average of 3 prior
open shoulder surgeries (max 15, min 1).

Clinical scores
• ASES scores improved from 62.9 to 68.3
(p=0.07)
• Constant improved from 37.0 to 44.2 (p=0.07)
• SANE improved from 32.7 to 41.7 (p=0.36)
• WOOS scores changed from 62.2 to 48.2
(p=0.02)
• Patient satisfaction levels improved by 16.3%
(p=0.03)

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Range of motion
• Range of motion improved in all directions
except active external rotation.
• AFF increased from 87° to 105° (p=0.06)
• AAB increased from 76° to 103° (p=0.01)
• Internal rotation also improved from between
the buttocks and lumbosacral junction to
between the lumbosacral junction and L3.
• Active external rotation decreased only
slightly from 20° to 17° (p=0.65)

Results – graft healing
• 14 of 23 grafts
healed
completely, an
additional 3 had
partial
incorporation of
the crest graft.
• There were only
6 frank graft
failures

Complications/Reoperations
• Unfortunately , 11 of the 23 (48%) shoulders required reoperation and removal of some or all of their glenoid
components during the follow up period.
–
–
–
–
–
–

3 of the shoulder were revised for base-plate loosing
2 for fracture of the glenoid following low energy trauma
3 for infection
1 for graft non-union
1 for graft fracture
1 for glenosphere baseplate disassociation.

• Three patients had humeral complications with fractures of
the shaft around the humeral stem necessitating
intervention highlighting the complex nature of this group
of patients.

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Discussion
• This is a complicated and heterogeneous group of
patients for whom glenoid bone loss is only one of the
challenges faced in restoring shoulder function.
• The overall all cause reoperation rate was high (48%)
• 14/23 (61%) of the bone grafts healed completely to
the native scapula and an additional 3 had some
incorporation for a total of 74% adequate graft
healing. This procedure represents a viable option for
single stage revision for massive glenoid defects.

• 12 ICBG (12/30 RSA in study)
• Average F/U 34 mo.
• FOS, AFF, AAB significantly increased
–
–
–
–

Adj Constant: 24.3-64.6
ASES: 54.8-71.8
AFF: 42.0-105.7
AAB: 39.4-97.7

1st Conclusions
• This procedure represents a viable
option for single stage revision for
massive glenoid defects.
• While this is a complex and difficult
group of patients to treat owing to
bone loss and multiple prior
operations, significant and durable
improvements in satisfaction, range
of motion and functional scores can
be obtained by using iliac crest to
reconstruct the glenoid.

5

2/16/2015

How to improve results?
• Base plate options
• Glenoid anatomy may determine 1 or 2-stage

Design advances
Ingrowth, locking screws
Mark 1 design

Long post base plate to engage native
scapula with bone grafts

SPBP

LPBP

THREADED or SCREW-IN BP
25-50 mm screw length

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2/16/2015

Base plate advances
– Base plate designs-one or multi-piece
– Fixation to native scapula with grafts
– Textures or ingrowth coatings
– Threaded BP 10-18x torque/compression
– Length options for bi-cortical fixation and grafts

Threaded Post Baseplate
• Fixation achieved at base of glenoid vault

Bicortical

Base plate low in the glenoid

TYPE 3

GBL

2A

1

2B

Norris TR, Abdus-Salaam S. Lessons learned from the Hylamer experience & technical salvage for
glenoid reconstruction. In: Walch G, Boileau P, Mole D, Favard L, Levigne C, Sirveaux F, editors.
Shoulder concepts 2010: the glenoid. Montpellier: Sauramps Medical; 2010. p. 265-78. ISBN 9782840232735.

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2/16/2015

Global Glenoid loss
(GBL type 3)
• Sideways TICBG
• Structural allograft
– Femoral head, neck or
shaft
– Humeral head when
using proximal humeral
combined graft
– BMP
– Consider staging

TICBG—2-stage reconstruction with threaded baseplate

Absent
glenoid

Stage 1-TICBG

Stage2 RSA

• Autograft-allograft composite
• 5 patients
• Preliminary results show
incorporation of the graft in all
pts
• no infections

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2/16/2015

Global GBL

TSAR-RSA-Sepsis GSL-Resection
Cause for sepsis
GL, RCT in TSA 2y

RSA
Bone resorption
SEPSIS

resection

2y

2y

GSL

Balandran-3ops

TSAR-RSA1-GBG allograft chips, SPBP
RSAR-TICBG fracture-NU
RSAR2-subside upwards-HO inferior-instability
RSAR3-PH allograft, FNA to glenoid to
lateralize

Op 8

Scapula fx

Allograft chips GBG
Short post BP
Burns 11 ops

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Scapula fx reaming-Staged RSA
Staged

SPBP

GSL

LPBP-stable

Goldkrause 5 ops

Early RSAs: placed mid glenoid
Impingement, osteolysis, notch, instability, GSL
GBL 2B
Reposition
GBL2B
LPBP lower
TICBG

Metalosis
osteolysis
TICBG

Goldman-10ops

Malposition high, levers out
dissociation

Inferior glenoid levers
out poly

Mangan 3ops

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2/16/2015

GS Dissociation-malposition BP high
TICBG, lower BP, GS lateralized

Mangan 3ops

Traumatic GSL in BIORSA
Staged reconstruction for GBL
Ant Fx dislocation-BIORSA
GSL-new fall

2-Stage TICBG

digiroloma-3ops

Conclusions
• Tricortical Iliac Crest Grafts offer a good option
for reconstructing glenoid bone loss in
revision arthroplasty
• Advances on base plate technology with long
posts and screws to engage the native scapula
will improve our outcomes.
• Scapular bone loss plays an important role in
whether the cases can be done in 1 or 2stages

11

The Use of Cancellous Bone Graft Harvested
from the Humeral Head (BIORSA Technique)
to Address Glenoid Deficiency:
A CT-Scan Study

Pascal Boileau, Nicolas Morin-Salvo, Gregory Moineau,
Thomas D’Ollonne, Patrick Gendre, Charles Bessière

Nice - France

Disclosure
Pascal Boileau – Royalties - Tornier

Preliminary study good results
for glenoid without bone deficiency !

CORR 2011
42 patients / 42 BIORSA
FU mean : 28 Months (24-40)
100% graft incorporated
No glenoid loosening
19% scapular notching
Excellent mobility

No instability

1

AIM
to report the results of the use of BioRSA
technique to address glenoid deficiency
1- Is graft large enough for glenoid bone deficiency ?

2- Does such a big graft heal ?
3- Scapular notching
4- Functional outcomes

Retrospective Monocentric study
Inclusion Criteria:
- glenoid bone deficiency : Favard E2,E3,E4 or Walch A2,B2,C
- RSA + bony-lateralization with humeral bone graft
- Patient reviewed with Xray + CT-scan > 1 year

Exclusion Criteria:
- BIO-RSA technique with Allograft or Iliac-crest graft
- Revision shoulder arthroplasty (failed hemi or total SA)

2006 to 2013

93 BIO-RSA for glenoid
bone deficiency
allograft 29,
iliac crest 10

63 BIO-RSA
humeral bone graft
2 died
7 lost FU < 1y

N = 54

2

BIO-RSA for Glenoid
Deficiency (n = 54)
Women 70% -

73 years

[52-85]

Cuff tears arthropathy
CTA
(31)
Osteoarthritis
OA
(13)
Osteoarthritis post-instability OA post-inst (2)
Rheumatoid arthritis
RA
(6)
Fracture Sequelae
SF
(2)

• FU mean : 33 m [12-81]

Glenoid Deficiency
Horizontal Plane (WALCH) A2,B2,C

A2 = 8

B2 = 15

C=7

Glenoid Deficiency
Vertical Plane (FAVARD) E2,E3,E4

E2 = 15

E3 = 21

E4 = 3

3

Radiographic Measurement of Glenoid Inclination
FAVARD inclination

1)
2)

GERBER inclination

Falaise, Lévigne, Favard, OTSR 2011 : scapular notching in reverse shoulder arthroplasty: influence of
glenometaphyseal angle
Maurer, Gerber, et al. JSES 2012 : assessment of glenoid inclination in routine clinical xray and ct-scan;

2D-CT-Scan Measurement of Glenoid Inclination & Version
MPR mode (Multi Planar Reconstruction)
GERBER inclination

1)
2)

FRIEDMAN version

Maurer, Gerber, et al : assessment of glenoid inclination in routine clinical xray and ct-scan; JESE 2012
Friedman, et al : the use of computized tomography in the measurement of glenoid version; JBJS Am 1992

RESULTS

4

Glenoid
Loosening
N = 2 (4%)

Revisions
N = 1 (2%)

Correction vertical deficiency
GERBER inclination =10°

27 m post-op

incl. pre-op
Rx

Total series (n = 54)
Favard E2, E3 (n=39)

27 m post-op

incl. pre-op incl. post-op
Ct-Scan
Rx

106.4°

104.9°

(71;142)

(68;139)

111°

112.1°

(95;142)

(96;138)

96.1° (ns)
(70;122)

97.6° (ns)

(70;122)

incl. post-op
Ct-Scan

95.9°

(ns)

(71;121°)

97.3°
(71;121)

(ns)

Correction vertical deficiency
FAVARD inclination = 10°

27 m post-op

incl. pre-op
Rx

Total series (n = 54)
Favard E2, E3 (n=39)

88.1° (54;117)
82° (54;106)

incl. post-op
Rx

98.1° (64;129)(p=0.003)
93.5° (68;118)(p=0.001)

5

Correction horizontal deficiency
= 10°
33m

post-op

asymetric
graft

version pre-op

Total series (n = 54)

- 12.1° (-49;+15)
- 21.1° (-49;0)

Walch B2, C (n=30)

version post-op

- 4.7° (-32;+21) (p=0.08)
-10.6° (-32;+4) (p=0.06)

GRAFT HEALING
FU mean : 33m [12-81]

52/54 Graft incorporated (96%)

3m Post-op

12m Post-op

18m Post-op

GRAFT HEALING
(CT-scan) FU mean : 33m [12-81]
52/54 Graft incorporated (96%)

E3 / C
combined

46 m post-op

6

Scapular notching
= 25%
(NONE NOTCH GRADE 4)

64m Post-Op

67m Post-Op

partial inferior graft lysis
= 11%
GRAFT
HEALED
partial inferior lysis
(remodelling)
24m Post-Op

Clinical outcomes (N=53)
Preop
absolut

CS

31 (9-62)

Postop

68 (30-89)

AAE

85° (20-170°)

148° (80°-180°) *

ER1

12° (-20°-60°)

24° (-20°-70°) *

IR1

S1 (3.2) (0-T12)

SSV

30% (10-60)

L4 (5.6) (0-D4) *
83% (0-100)
* P < 0.05

NO INSTABILITY

7

CONCLUSION
 Correct axis + Treat glenoid deficiency
 inclination
-10°

 Version

+10°

30°

45°

CONCLUSION
 Graft heals and remains viable in 96%
(2 failures = 1) technical error, 2)traumatic loosening)

 Notch 25%

GRAFT HEALING

6m post-op

2y post-op

5y post-op

PERSPECTIVES
3D-planning

cut-guide & graft
dimension
personalized

Thank you for your attention!

8

2/16/2015

Reverse TSA - How to
Handle Glenoid Bone Loss
Thomas W. Wright MD
University of Florida
Department of Orthopaedics

Disclosure

• Design Surgeon for Exactech
–Institutional research support
–Royalties

Introduction Glenoid Wear - RTSA

• Reaming solutions
• Bone graft Solutions
• Metal solutions
• Early Outcomes

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Glenoid Bone Loss - Reaming
• Ream to correct deformity
–Give up valuable subchondral
bone
–Correct only about 15 degrees
–Glenoid shrinks

Eccentric Reaming

How much can I correct it?
Issues w/ eccentric reaming:
•
•
•
•

Insufficient bone stock
Implant downsizing
Peg Perforation
Implant loosening loss subchondral
support

2

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Glenoid Bone Loss - Grafting
• Bone Graft defect
–Humeral head autograft if present
–Allograft or autograft iliac crest
–Technically demanding
–Graft needs to heal
–Use extended post

Cases Humeral Head Autograft

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Glenoid Bone Loss – Metal Solutions

• Metal soutions
–Posterior augment
–Superior augment
–Posterior – superior augment
–Lateralized glenosphere

Hypothesis
• Severe Glenoid Wear
treated metal augments
will have comparable
outcomes RTSA patients
with normal glenoid

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Metal Solutions Augmented
Baseplates

Case – Augmentation with Metal

• 60 failed hemi
• Previous surgery for instability
• Pain/ bad function

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Superior Augmented Baseplate

Superior Augmented Baseplate
• 29 Patients
–20 primary
–9 revision

• Age - 70
• Average F/U – 18 months
• Complication – 1 dislocation

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2/16/2015

Superior Augmented Baseplate
SPADI
100

SST

ASES

UCLA

Constant
Nrl

Pre op

69

4

33

13

33

Final
F/U

32

8

71

28

67

Change

-37
good

+4

+38

+15

+34

9

79

29

76

Control 2 22
year

Superior Augmented Objective
Outcomes
Active
elevation

Active
External Rot

Active Internal
Rot

Preop

75

17

S2

Post Op

116

28

L3

Improvement

+41

+11

Control

127

27

+5 anatomic
segments
L3

Augmentation Metal-Lateralized

• Lateral Center of Rotation
Implant
–Encore – 32std and 32-4
–Exactech – lateralized
glenosphere
–Others

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Lateral Center Of Rotation

Lateralized Glenosphere

Medial Wear

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Superior Augment/Lateralized
Glenosphere

Lateralized Glenosphere

• N=29
• Age – 67
• Follow-up Ave – 8 months
• One dislocation

Lateralized Glenosphere Functional
Outcomes
SPADI 100

SST

ASES

UCLA

Constant
Nrl

Pre Op

75

3

30

11

28

Final
F/U

34

8

70

27

59

Improvem
ent

-41 +5
Good
30
9

+40

+16

+31

70

27

67

Control 1
year

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2/16/2015

Lateralized Glenosphere Objective
Active
Elevation

Active
External Rot

Active Internal
Rot

Pre Op

61

12

S2

Final F/U

97

19

L5

Improvem +36
ent

+7

Control 1
yr

23

+2
anatomic
Seg
L4

118

Posterior Wear

Posterior Augmented Baseplate

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2/16/2015

Posterior Augmented Baseplate
• N=42
• Age – 71
• Follow-up Average – 12 months
• Complications – 1 intraop
tuberosity fx

Functional Outcomes Posterior
Augmented
SPADI 100

SST

ASES

UCLA

Constant Nrl

Pre Op

58

4

43

15

44

Post Op

19

10

81

30

74

Improvement

-39 +6
Good

+38

+15

+30

Control 1 yr

30

70

27

67

9

Objective Outcomes Posterior
Augmented
Active Elevation

Active External
Rot

Active Internal
Rot

Preop

87

18

S2

Final F/U

127

26

L3

Change

+40

+8

Control 1 yr

118

23

+4
Anatomic
Seg
L4

11

2/16/2015

Posterior Superior Augment
• Severe glenoid wear
• Previously only treatment –
bone grafting
• Posterior superior wear
patterns – common in CTA
• N=5 only 6 months average f/u

Posterior Superior Augment

Posterior Superior Augment

12

2/16/2015

Posterior Superior Augment
Functional Outcomes
SPADI 100

SST

ASES

UCLA

Constant Nrl

Preop

65

5

46

13

38

Final
follow –
up 6
months
Change

29

8

75

27

57

36

3

29

14

19

Control 6 34
months

8

68

26

61

Posterior Superior Augment
Outcomes
Active
elevation
Preop

62

Active
External
Rotation
16

Active Internal
Rotation

Final Followup

101

35

S1

Change

39

19

4

Control 6
months

111

21

L5

S%

Conclusion Ugly Glenoid
•
•
•
•

Be Aware
Know the solutions
Solutions are in evolution
Can make a big difference with patient
– Pain
– Function
– Durability implant

• Based on Short term f/u metal
augments are a viable solution

13

2/16/2015

14



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