Does Glenoid Version and its Correction Impact Outcomes in Anatomic Shoulder Arthroplasty

Authors:

Rutledge JC, Dey Hazra RO, Geissbuhler AR, Yamaura K, Dey Hazra ME, Hanson JA, Rupp MC, Millett PJ

Abstract:

Background:

Correction of glenoid retroversion is commonly performed in anatomic total shoulder arthroplasty (TSA) to increase component contact area and decrease eccentric loading of the glenoid component. Despite demonstrated biomechanical advantages, limited information exists on the clinical benefit of correcting glenoid retroversion. The purpose of this systematic review is to critically evaluate the existing literature on the effect of preoperative and postoperative glenoid retroversion on clinical functional and radiological outcomes in patients who underwent anatomic TSA.

Methods:

A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses utilizing PubMed, Embase, and Cochrane Library evaluating the impact of glenoid retroversion on clinical and radiological outcomes of TSA. English-language studies of Level I through IV evidence were included. Blinded reviewers conducted multiple screens and methodological quality was appraised utilizing the Modified Coleman Methodology Score.

Results:

Sixteen studies, including three level III and thirteen level IV studies (1211 shoulders), satisfied all inclusion criteria. To address glenoid retroversion, nine studies utilized corrective reaming techniques, and four studies utilized posteriorly augmented glenoids. Two studies utilized non-corrective reaming techniques. Mean preoperative retroversion ranged from 12.7° to 24° across studies. Eleven studies analyzed the effect of glenoid retroversion on clinical outcomes, including patient reported outcome scores (PROs), range of motion (ROM), or clinical failure/revision rates. The majority of the studies (8/11) did not report any significant association of pre- or postoperative glenoid retroversion on any clinical outcome. Of the three studies that reported significant effects, one study reported a negative association between preoperative glenoid retroversion and PROs, one study reported inferior postoperative abduction in patients with postoperative glenoid retroversion greater than 15 degrees, and one study found an increased clinical failure rate in patients with higher postoperative retroversion. Ten studies reported radiographic results (medial calcar resorption, central peg lucency (CPL) grade, Lazarus lucency grade) at follow-up. Only one study reported a significant effect of pre- and postoperative retroversion greater than 15 degrees on CPL grade.

Conclusion:

There is currently insufficient evidence that pre- or postoperative glenoid version influences postoperative outcomes independent of other morphologic factors such as joint line medialization. Given that non-corrective reaming demonstrated favorable postoperative outcomes, and postoperative glenoid version was not significantly and consistently found to impact outcomes, there is inconclusive evidence that correcting glenoid retroversion is routinely required.

You may request the complete study: Does Glenoid Version and its Correction Impact Outcomes in Anatomic Shoulder Arthroplasty – a Systematic Review

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!