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 virtual surgery—A software solution

Inaccurate placement of glenoid prosthesis in shoulder arthroplasty can lead to early loosening, instability, and failure. To address difficult glenoid morphology, patient-specific instrumentation and navigation techniques have been developed. Advanced imaging data has demonstrated utility in preoperative decision making. Cadaveric studies have subsequently shown that the application of advancing imaging and navigation can lead towards increased accuracy with prosthesis placement. Clinical trials have also shown increased accuracy with navigation and advanced imaging, but data demonstrating improved long-term outcomes and decreased complication rates is not yet available. This technology continues to evolve as a method to address glenoid bone loss and abnormal morphology.     

Surgical treatment of nonconstrained glenoid component failure

Total shoulder replacement for pathological conditions of the glenohumeral joint has proven to be a very durable procedure with a low complication rate and a high rate of patient satisfaction. Glenoid component revision rates reported in the literature are generally less than 4% (range, 0 to 12.5%) for nonconstrained total shoulder replacements at 3- to 5-year follow-up. Glenoid component failure occurs as a result of loosening, breakage, or damage of the glenoid component. The causes for glenoid component failure include infection, trauma, eccentric loading after a rotator cuff tear, and technical errors. Technical factors include inadequate glenoid bone contouring allowing rocking of the platform, excessive cement buildup with noncontained cement that may break free and allow toggling of the platform, and component malalignment or poor soft tissue balancing leading to dislocations with associated loosening or breakage. The patients experience pain and loss of motion, and diagnostic radiographs often reveal a progressive increase in radiolucencies around the glenoid component. Treatment consists of glenoid component replacement when bone stock allows or glenoid component removal with upsizing of the humeral head when bone stock is insufficient to support a new component. In the case of infection, removal of both components is advocated. Results of glenoid component revision surgery are satsifactory in the majority of cases, with patients who have intact and normally functioning deltoid and rotator cuff muscles faring better than those who have some form of compromise.