Treatment of Shoulder Osteoarthritis With Intact Rotator Cuff and Severe Glenoid Retroversion.

The American Academy of Orthopaedic Surgeons has developed an Appropriate Use Criteria (AUC) for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to determine the appropriateness of various treatments of shoulder osteoarthritis with intact rotator cuff and severe glenoid retroversion. The AUC for Treatment of Shoulder Osteoarthritis with Intact Rotator Cuff and Severe Glenoid Retroversion were derived by identifying scenarios evident during the clinical decision-making process on this topic. These scenarios relied on definitions and general assumptions, mutually agreed upon by the writing panel during scenario development. These definitions and assumptions were necessary to provide consistency in the interpretation of the clinical scenarios among experts rating the scenarios and readers using the final criteria. Writing panel members of this AUC developed patient scenarios using these guiding principles: comprehensive (covers a wide range of patients), mutually exclusive (no overlap between patient scenarios/indications), homogeneous (final ratings should result in equal application in each of the patient scenarios), and manageable (number of total rating items [ie, number of patient scenarios × number of treatments] should be practical for the rating panel). The target number of total rating items was <1,500. This means that not all patient indications and treatments can be assessed using AUC. A total of 240 patient scenarios and five treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, rating panel (made up of specialists and non-specialists) rated the appropriateness of treatment of each patient scenario using a nine-point scale to designate a treatment as "appropriate" (median rating, 7 to 9), "may be appropriate" (median rating, 4 to 6), or "rarely appropriate" (median rating, 1 to 3).

Augmented wedge-shaped glenoid component for the correction of glenoid retroversion: a finite element analysis.

BACKGROUND: This study undertook a computational analysis of a wedged glenoid component for correction of retroverted glenoid arthritic deformity to determine whether a wedge-shaped glenoid component design with a built-in correction for version reduces excessive stresses in the implant, cement, and glenoid bone. Recommendations for correcting retroversion deformity are asymmetric reaming of the anterior glenoid, bone grafting of the posterior glenoid, or a glenoid component with posterior augmentation. Eccentric reaming has the disadvantages of removing normal bone, reducing structural support for the glenoid component, and increasing the risk of bone perforation by the fixation pegs. Bone grafting to correct retroverted deformity does not consistently generate successful results. METHODS: Finite element models of 2 scapulae models representing a normal and an arthritic retroverted glenoid were implanted with a standard glenoid component (in retroversion or neutral alignment) or a wedged component. Glenohumeral forces representing in vivo loading were applied and stresses and strains computed in the bone, cement, and glenoid component. RESULTS: The retroverted glenoid components generated the highest compressive stresses and decreased cyclic fatigue life predictions for trabecular bone. Correction of retroversion by the wedged glenoid component significantly decreased stresses and predicted greater bone fatigue life. The cement volume estimated to survive 10 million cycles was the lowest for the retroverted components and the highest for neutrally implanted glenoid components and for wedged components. CONCLUSION: A wedged glenoid implant is a viable option to correct severe arthritic retroversion, reducing the need for eccentric reaming and the risk for implant failure.