Analysis and 3D correction of glenoid dysplasia with metal hemi-wedge base plate augment: short-term radiographic outcomes

BACKGROUND: Glenoid defects can be addressed traditionally by asymmetric reaming or by bone-preserving correction to a more lateral joint line by bone or metal augmented baseplates in reverse shoulder arthroplasties. While there is more evidence in literature regarding the outcome and complications of Bony Increased Offset Reversed Shoulder Arthroplasty (BIO-RSA), there is minimal reported experience with the outcome after metal glenoid augments. The aim of this study was to determine whether a metal augment can correct the glenoid deformity in an anatomic manner. METHODS: Glenoid morphology and deformity were determined in 50 patients with Walch type B1, B2, D and Favard type E0–E3 glenoid defects using preoperative radiographic and computed tomography (CT) analysis. All patients received a preoperative planning CT with 3D planning, and measurements of glenoid inclination (in 3 planes proximal, middle, distal), reversed shoulder arthroplasty angle (RSA) and glenoid version were obtained. All patients had a pathologic inclination in the coronal or frontal planes of > 10°. Above the threshold of 10° pathological glenoid version or inclination metal hemi-augments of 10°, 20°, or 30° were used which allow an individual 360° augment positioning according to the patient glenoid deformity. RESULTS: The mean preoperative numbers of the glenoid version demonstrate that most glenoids were in retroversion and superior inclination. In total 2410° wedges, 1820° wedges and 8 30° wedges were used. In the majority of cases, the wedge was positioned posteriorly and/or cranially between 10:00 and 12:00 o’clock, which allows a correction in a 3D manner of the glenoid inclination and version. The mean RSA angle could be corrected from 22.76 ± 6.06 to 0.19° ± 2.7 (p < 0.0001). The highest retroversion of the glenoid is evidenced in the proximal section and it could be corrected from − 23.32° ± 4.56 to − 6.74° ± 7.75 (p < 0.0001) and in the middle section from − 18.93° ± 3.35 to − 7.66° ± 5.28 (p < 0.0001). A mean sphere bone overhang distance (SBOD) of 5.70 ± 2.04 mm was found in order to avoid or minimize relevant scapular notching. CONCLUSION: By using a new 360° metal-augmented baseplate, the preoperative pathological inclination and retroversion can be corrected without medialization of the joint line. Future clinical results will show whether this bone-preserving procedure improves also the clinical outcomes as compared to asymmetric medialized reaming or wedged BIO-RSA. LEVEL OF EVIDENCE: Level IV, Case series.