Microcomputed tomography assessment of glenoid component cementation techniques in total shoulder arthroplasty

Various strategies have been described to improve glenoid component cementation technique in shoulder arthroplasty, such as the “weephole” technique (WH), which is thought to allow for improved cement mantles by suction venting the glenoid vault through the coracoid. The purpose of this study was to compare the cement mantle created using standard syringe pressurization (SP) to WH or a new, modified weephole technique (MWH), not requiring specific instrumentation of the coracoid medullary canal. Fourteen cadaveric scapulae underwent preparation of the glenoid to allow for implantation of glenoid components. Component fixation was achieved using SP, WH, or MWH. The volumes of cement surrounding each individual peg on the component, of the cement mantle between the back of the glenoid, and of the reamed glenoid face were quantified using micro‐CT. Compared to SP, significantly larger cement mantles were observed around all pegs with both the WH (p = 0.023) and MWH (p = 0.007). Similarly, both the WH and MWH techniques demonstrated significantly decreased cement behind the glenoid component (p = 0.003) compared to SP, with no significant difference between the WH and the MWH techniques. Both WH and MWH techniques increase cement mantle volume around individual pegs and decrease the amount of glenoid face cement compared to conventional SP. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:559–564, 2010     

Managing glenoid bone loss in total shoulder arthroplasty: Role of augmented patient-specific implants

Total shoulder arthroplasty has been shown to generate good to excellent results for patients with osteoarthritis and a functioning rotator cuff. However, a major complication after primary total shoulder arthroplasty is loosening of the glenoid component, which has been shown to be commonly associated with glenoid retroversion. This article highlights the importance of correcting the glenoid version and reviews various techniques, such as eccentric reaming, posterior bone grafting, reverse shoulder arthroplasty, and augmented glenoid implantation to address glenoid retroversion in the setting of total shoulder arthroplasty.