Bone Loss In Shoulder Arthroplasty Syllabus

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1

Carl J. Basamania, MD, FACS

The PolyClinic and

Swedish Orthopaedic Institute

Seattle, Washington

B2 Glenoid Bone Loss and

Shoulder Arthroplasty:

Bone Grafts and Augmented

Glenoid Components

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

2

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

3

Glenoid with Posterior

Erosion

Bone

Graft

Bone Grafting

•Restores the

original glenoid

plane

•Malunion, non-

union, and

increased surgical

time

•10 fold higher

failure rate than

normal TSA

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

4

5

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?

6

Can you use an augmented

glenoid?

Glenoid with

Posterior Erosion

Augmented Glenoid

•No medialization

•No implant

undersizing

•No need to bone

graft

•Re-establishes

normal joint line

•Returns cuff to

normal tension

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

7

13°

Design Rationale (cont.)

•Spherical anterior backside

•Conical posterior backside (13 degree

angle)

–Design effectively counteracts posterior

loading

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

8

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

9

Surgical Technique

Glenoid Exposure

Walch B2

Anterior Reaming

10

Posterior Guide

Oscillating Rasp

Glenoid “Hoes”

11

Posterior Step

Peripheral Drill Holes

Final Implant

12

Case Example:

60 year old female

Posterior glenoid erosion

13

Thanks!

2/16/2015

1

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

2/16/2015

2

« 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…

2/16/2015

3

Same patient at

2 ≠ levels

B2

A2

1/ level of the cut

may change the

glenoid shape

Biconcave

Concentric

1997

1995

2013

1999

B1

B2 C

B2

2/ osteophyte’s anterior reconstruction

Biconcave becomes concentric…

Osteophyte’s anterior reconstruction

Eccentric glenoid becomes a concentric one !

2/16/2015

4

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

2/16/2015

5

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 )

5y 9y

13y

Case 1 Case 2 Case 3

2/16/2015

6

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

B2 and Reverse SA 1998-2009

27 cases –54 m f-up

Reverse Prosthesis ( 2 stages)

Structural bone graft (1 stage)

2/16/2015

7

Results

Preop. Postop. p value

Pain 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

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

IR Buttocks T12 < 0.0001

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

2/16/2015

8

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 !

2/16/2015

1

Tom R. Norris MD

VuMedi Webinar:

Bone Loss in Shoulder Arthroplasty

February 17, 2015

Tricortical Iliac Crest Bone Grafts

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.

2/16/2015

2

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



2/16/2015

3

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)

2/16/2015

4

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 re-

operation 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.

2/16/2015

5

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.

2/16/2015

6

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

2/16/2015

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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

Base plate low in the glenoid

Bicortical

GBL

1

2A

2B

TYPE 3

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 978-

2840232735.

2/16/2015

8

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

Stage 1-TICBG Stage2 RSA

Absent

glenoid

•Autograft-allograft composite

•5 patients

•Preliminary results show

incorporation of the graft in all

pts

•no infections

2/16/2015

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Global GBL

TSAR-RSA-Sepsis GSL-Resection

Balandran-3ops

GL, RCT in TSA 2y RSA

Bone resorption

SEPSIS

Cause for sepsis

resection

2 y

2 y

GSL

Burns 11 ops

Allograft chips GBG

Short post BP

Scapula fx

Op 8

TSAR-RSA1-GBG allograft chips, SPBP

RSAR-TICBG fracture-NU

RSAR2-subside upwards-HO inferior-instability

RSAR3-PH allograft, FNA to glenoid to

lateralize

2/16/2015

10

Scapula fx reaming-Staged RSA

SPBP LPBP-stable

Goldkrause 5 ops

GSLStaged

Early RSAs: placed mid glenoid

Impingement, osteolysis, notch, instability, GSL

GBL2B

Goldman-10ops

GBL 2B

Reposition

LPBP lower

TICBG

TICBG

Metalosis

osteolysis

Malposition high, levers out

dissociation Inferior glenoid levers

out poly

Mangan 3ops

2/16/2015

11

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 2-

stages

1

The Use of Cancellous Bone Graft Harvested

from the Humeral Head (BIORSA Technique)

to Address Glenoid Deficiency:

A CT-Scan Study

Nice - France

Pascal Boileau, Nicolas Morin-Salvo, Gregory Moineau,

Thomas D’Ollonne, Patrick Gendre, Charles Bessière

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

2

AIM

1- Is graft large enough for glenoid bone deficiency ?

2- Does such a big graft heal ?

3- Scapular notching

4- Functional outcomes

to report the results of the use of BioRSA

technique to address glenoid deficiency

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)

2 died

7 lost FU < 1y

93 BIO-RSA for glenoid

bone deficiency

63 BIO-RSA

humeral bone graft

allograft 29,

iliac crest 10

2006 to 2013

N = 54

3

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

E4 = 3E3 = 21E2 = 15

4

GERBER inclination

FAVARD inclination

1) Falaise, Lévigne, Favard, OTSR 2011 : scapular notching in reverse shoulder arthroplasty: influence of

glenometaphyseal angle

2) Maurer, Gerber, et al. JSES 2012 : assessment of glenoid inclination in routine clinical xray and ct-scan;

Radiographic Measurement of Glenoid Inclination

FRIEDMAN versionGERBER inclination

1) Maurer, Gerber, et al : assessment of glenoid inclination in routine clinical xray and ct-scan; JESE 2012

2) Friedman, et al : the use of computized tomography in the measurement of glenoid version; JBJS Am 1992

2D-CT-Scan Measurement of Glenoid Inclination & Version

MPR mode (Multi Planar Reconstruction)

RESULTS

5

Glenoid

Loosening

N = 2 (4%)

Revisions

N = 1 (2%)

Correction vertical deficiency

GERBER inclination =10°

incl. pre-op

Rx

incl.

pre-

op

Ct-Scan

incl. post

-

op

Rx

incl. post-

op

Ct-Scan

Total

series (n = 54) 106.4°

(71;142)

104.9°

(68;139)

96.1°

(70;122)

95.9°

(71;121°)

Favard

E2, E3 (n=39) 111°

(95;142)

112.1°

(96;138)

97.6°

(70;122)

97.3°

(71;121)

27 m post-op

27 m post-op

(ns)

(ns)(ns)

(ns)

Correction vertical deficiency

FAVARD inclination = 10°

incl. pre-op

Rx

incl. post-op

Rx

Total

series (n = 54) 88.1°(54;117) 98.1°(64;129)

Favard

E2, E3 (n=39) 82°(54;106) 93.5°(68;118)

27 m post-op

(p=0.003)

(p=0.001)

6

Correction horizontal deficiency

= 10°

version pre-op version post-op

Total

series (n = 54) -12.1°(-49;+15) -4.7°(-32;+21)

Walch

B2, C (n=30) -21.1°(-49;0) -10.6°(-32;+4)

asymetric

graft

33m post-op

(p=0.08)

(p=0.06)

52/54 Graft incorporated (96%)

3m Post-op 18m Post-op

GRAFT HEALING

FU mean : 33m [12-81]

12m Post-op

52/54 Graft incorporated (96%)

GRAFT HEALING

(CT-scan) FU mean : 33m [12-81]

46 m post-opE3 / C

combined

7

Scapular notching

= 25%

64m Post-Op

67m Post-Op

(NONE NOTCH GRADE 4)

partial inferior graft lysis

= 11%

24m Post-Op

GRAFT

HEALED

partial inferior lysis

(remodelling)

NO INSTABILITY

Clinical outcomes (N=53)

Preop Postop

absolut CS 31(9-62) 68 (30-89)

AAE 85°(20-170°)148°(80°-180°) *

ER1 12°(-20°-60°)24°(-20°-70°) *

IR1 S1 (3.2) (0-T12) L4 (5.6) (0-D4) *

SSV 30% (10-60) 83% (0-100)

* P < 0.05

8

45°30°

Correct axis + Treat glenoid deficiency

inclination -10°

Version +10°

CONCLUSION

Graft heals and remains viable in 96%

(2 failures = 1) technical error, 2)traumatic loosening)

Notch 25%

CONCLUSION

GRAFT HEALING

6m post-op 2y post-op 5y post-op

PERSPECTIVES

3D-planning

Thank you for your attention!

cut-guide & graft

dimension

personalized

2/16/2015

1

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

2/16/2015

2

Glenoid Bone Loss - Reaming

•Ream to correct deformity

–Give up valuable subchondral

bone

–Correct only about 15 degrees

–Glenoid shrinks

Eccentric Reaming

Issues w/ eccentric reaming:

•Insufficient bone stock

•Implant downsizing

•Peg Perforation

•Implant loosening loss subchondral

support

How much can I correct it?

2/16/2015

3

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

2/16/2015

4

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

2/16/2015

5

Metal Solutions Augmented

Baseplates

Case –Augmentation with Metal

•60 failed hemi

•Previous surgery for instability

•Pain/ bad function

2/16/2015

6

Superior Augmented Baseplate

Superior Augmented Baseplate

•29 Patients

–20 primary

–9 revision

•Age - 70

•Average F/U –18 months

•Complication –1 dislocation

2/16/2015

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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

Control 2

year

22

9

79

29

76

Superior Augmented Objective

Outcomes

Active

elevation

Active

External Rot

Active Internal

Rot

Preop

75

17

S2

Post Op

116

28

L3

Improvement

+41

+11

+5 anatomic

segments

Control

127

27

L3

Augmentation Metal-Lateralized

•Lateral Center of Rotation

Implant

–Encore –32std and 32-4

–Exactech –lateralized

glenosphere

–Others

2/16/2015

8

Lateral Center Of Rotation

Lateralized Glenosphere

Medial Wear

2/16/2015

9

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

Good

+5

+40

+16

+31

Control 1

year

30

9

70

27

67

2/16/2015

10

Lateralized Glenosphere Objective

Active

Elevation

Active

External Rot

Active Internal

Rot

Pre

Op

61

12

S2

Final

F/U

97

19

L5

Improvem

ent

+36

+7

+2

anatomic

Seg

Control 1

yr

118

23

L4

Posterior Wear

Posterior Augmented Baseplate

2/16/2015

11

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

Good

+6

+38

+15

+30

Control 1

yr

30

9

70

27

67

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

+4

Anatomic

Seg

Control 1

yr

118

23

L4

2/16/2015

12

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

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Posterior Superior Augment

Functional Outcomes

SPADI 100

SST

ASES

UCLA

Constant Nrl

Preop

65

5

46

13

38

Final

follow

–

up 6

months

29

8

75

27

57

Change

36

3

29

14

19

Control 6

months

34

8

68

26

61

Posterior Superior Augment

Outcomes

Active

elevation

Active

External

Rotation

Active Internal

Rotation

Preop

62

16

S%

Final Follow

-

up

101

35

S1

Change

39

19

4

Control 6

months

111

21

L5

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

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