The functional and radiographic outcomes of nonaugmented anatomic total shoulder arthroplasty in patients with Walch B3 glenoid deformities

Abstract

BackgroundAchieving a durable result with anatomic total shoulder arthroplasty (aTSA) in shoulders with glenoid retroversion deformities, specifically Walch B3 glenoid deformities, can be a challenge. In this retrospective series, we report the mid-term clinical and radiographic follow-up of aTSA in patients with B3 glenoids with nonaugmented polyethylene implants. MethodsPatients who had undergone aTSA at a single institution by fellowship-trained surgeons between January 2013 and August 2017 with a preoperative computed tomography scan demonstrating a B3 glenoid were identified. All patients underwent aTSA with a lesser tuberosity osteotomy and a nonaugmented all-polyethylene glenoid. Eccentric reaming was performed to achieve near complete seating of the glenoid component with less emphasis on retroversion. Patients were contacted to complete patient-reported outcome scores and radiographic review. Immediate postoperative radiographs were assessed for posterior humeral subluxation measured relative to the axis of the glenoid component and implant seating. Final radiographs were reviewed for glenoid loosening using Lazarus rating and change in posterior humeral subluxation. ResultsTwenty-five subjects met inclusion criteria and were available for follow-up. The cohort had a mean age of 65.1 (range: 55-81) years and consisted of 6 females (24%; 6/25). These patients had a mean follow-up of 6.2 years (range: 3.9-8.4). American Shoulder and Elbow Surgeons improved from 38.2 ± 13.2 to 90.0 ± 16.9 (P < .001). Eighty percent (20/25) of these patients were available for radiographic review and had an average Lazarus grade of 1.9 (range: 0-5). There was no change in mean posterior glenohumeral subluxation (4.6% vs. 2.3%; P = .15) relative to their immediate postoperative films. The 12 patients with a Lazarus grade less than 2 had a greater Western Ontario Osteoarthritis of the Shoulder Index (96.9 ± 1.3 vs. 67.4 ± 12.8; P < .001), American Shoulder and Elbow Surgeons (94.0 ± 5 vs. 76.3 ± 16; P = .03), Single Assessment Numeric Evaluation (88.2 ± 8.7% vs. 66.7 ± 15%; P = .02), and satisfaction (98.5 ± 0.7% vs. 79.9 ± 13.2%; P = .002) compared to the 8 patients with a Lazarus grade more than or equal to 2. These 8 patients were more likely to have had severe preoperative biplanar deformity (retroversion >25° and inclination >10°) than the 12 without early glenoid radiolucency (63% [5/8] vs. 17%; P = .04). ConclusionAt mid-term follow-up, aTSA with standard implants for B3 glenoid deformity provides a reliable treatment option for restoration of function and improvement in pain. Mid-term radiographic review demonstrated development of early glenoid component lucencies in shoulders with severe biplanar deformities with associated deterioration in their clinical function. Long-term follow-up is needed to understand the clinical and radiographic outcome durability after aTSA in the setting of a B3 glenoid.