Non-spherical humeral head with inlay glenoid re-centers the
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Treatment of glenohumeral osteoarthritis (OA) with Walch type B glenoid poses a challenge for orthopedic surgeons. Researchers hypothesized that total shoulder arthroplasty (TSA) using a combination of non-spherical humeral head resurfacing (HHR) and inlay glenoid replacement would re-center the glenohumeral joint in patients with Walch type B glenoid without surgical correction of glenoid version.

Patients who underwent TSA using a combination of non-spherical HHR and inlay glenoid replacement for primary glenohumeral OA with posteriorly subluxated humeral head (HH) (Walch Type B1, B2 and B3) were screened. Ratios of preoperative and postoperative HH subluxation were compared using Walch index and the point of contact ratio method. Means of 2 independent measurements were included in the final analysis for each shoulder.

Results:
--Initial cohort included 49 patients. A total of 29 shoulders in 28 patients were eligible for screening.

--The numbers of shoulders with Walch type B1, B2, and B3 glenoids were 3, 22, and 4, respectively.

--Mean preoperative and postoperative Walch indices were 56.57 ± 6.08% and 49.47 ± 4.78%, respectively.

--The mean preoperative and postoperative point of contact ratios were 62.97 ± 8.45% and 50.08 ± 3.87%, respectively.

--The difference between preoperative and postoperative subluxation ratios was significant for both methods. Inter-rater reliability was found to be good-excellent.

--The overall complication rate at a mean follow-up period of 37.79 months was 10.34% (3/29). 1 patient experienced deep vein thrombosis (DVT) (3.22%) on postoperative day 8.

--2 patients experienced infection (6.45%), one of which required a revision TSA (3.22%) at 19 months after surgery. No patient experienced shoulder dislocation and no loosening was detected on postoperative radiographs.

Finally, glenohumeral re-centering was consistently observed in this challenging patient population when combined with an inlay glenoid portion in patients with eccentric glenoid wear and posterior subluxation without the use of joint correction or augmentation procedures.

Source: https://www.jsesarthroplasty.org/article/S1045-4527(21)00022-5/fulltext
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