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Nonstandard glenoid components for bone deficiencies in shoulder arthroplasty As in the prior post, these authors grapple with the issue of glenoid bone deficiency in total shoulder arthroplasty. In this article, they evaluated the clinical and radiographic outcomes in 38 patients having a primary or revision anatomic shoulder arthroplasty with one of 3 nonstandard glenoid components: a polyethylene component with an angled keel for posterior glenoid wear without posterior subluxation; a polyethylene component with 2 mm of extra thickness for central glenoid erosion; or a posteriorly augmented metal-backed glenoid component for posterior glenoid wear and posterior subluxation. The average clinical follow-up was 7.3 years (range, 2-19 years) or until revision surgery. While overall the patients were improved, thirteen had moderate or severe subluxation preoperatively, and 11 had subluxation at follow-up. Three glenoid components had loosened and 3 were at risk for loosening at...

Structural bone grafting for glenoid deficiency in primary total shoulder arthroplasty. These authors reviewed 25 shoulders (representing about 1% of the total number of primary total arthroplasties they performed over the same time period) having a structural bone graft (humeral head autograft and screw fixation) as a glenoid bone augmentation prior to glenoid component placement. Mean clinical and radiographic followup were about 8 years. On radiographic evaluation, 10 shoulders had glenoids at risk for component loosening. Two of these shoulders were symptomatic and underwent revision surgery to address glenoid component loosening. Although most of the patients were clinically improved, this study points to the challenges of total shoulder arthroplasty in the management of a retroverted glenoid with posterior humeral instability. The large forces on the back of the glenoid threaten fixation of the graft and the component. We have used the ream and run procedure for carefully se...