Clinical and Radiographic Outcomes of a Posteriorly Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for Primary Osteoarthritis with Posterior Glenoid Bone Loss.

BACKGROUND: The primary objectives of this study were to evaluate the ability of a posteriorly stepped augmented glenoid component, used in patients with primary glenohumeral osteoarthritis with B2 or B3 glenoid morphology, to correct preoperative retroversion and humeral head subluxation and to identify factors associated with radiographic radiolucency and patient-reported clinical outcomes.

METHODS: We identified 71 shoulders with B2 or B3 glenoid morphology that underwent anatomic total shoulder arthroplasty with use of a posteriorly stepped augmented glenoid component and with a preoperative 3-dimensional computed tomography (3D-CT) scan and a minimum of 2 years of clinical and radiographic follow-up. The Penn Shoulder Score (PSS), shoulder range of motion, glenoid center-peg osteolysis, and postoperative version and humeral head subluxation were the main outcome variables of interest.

RESULTS: Follow-up was a median of 2.4 years (range, 1.9 to 5.7 years); the mean patient age at treatment was 65 ± 7 years (range, 51 to 80 years). PSS, range of motion, humeral head centering, and glenoid version were significantly improved among all patients (p < 0.0001). Patients with persistent posterior subluxation of the humeral head postoperatively had worse preoperative fatty infiltration of the teres minor and greater postoperative component retroversion (p < 0.05). Patients with center-peg osteolysis had more preoperative joint-line medialization and posterior glenoid bone loss (p < 0.05). Patients with more preoperative humeral head posterior subluxation had a lower PSS, adjusting for confounders (p < 0.05).

CONCLUSIONS: Posteriorly stepped augmented glenoid components can improve pathologic retroversion and posterior subluxation of the humeral head in B2 and B3 glenoids, with significant improvements found in clinical outcome scores at a minimum of 2 years of follow-up in the vast majority of patients.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.