Managing Glenoid Bone Deficiency—The Augment Experience in Anatomic and Reverse Shoulder Arthroplasty
TAKE-HOME POINTS
- Glenoid defects are very common.
- Options for treating glenoid defects include eccentric reaming, bone grafting, and augmented glenoids.
- As computer-assisted surgery use becomes more widespread the use of augments in both TSA and RTSA will become very common.
- Subchondral bone is precious and cannot be replaced once reamed away. Eccentric glenoids introduce a mechanism to minimize reaming and preserve this precious bone.
- On short-term to midterm follow-up augments perform at least as well if not better than non-augmented glenoid components with complication rate and revisions likewise similar.
CONCLUSION
Augments offer an excellent tool for surgeons performing both aTSA and RTSA with glenoid bone loss. Use of augments will become more common as more manufacturers develop them. Although clinical results fall short in full midterm, they have been positive for both augmented RTSA and aTSA. Concerns arise when performing augmented aTSA, as an upper limit of correction has not been defined with regard to component failure. Currently, no data support the maximum amount of correction that can be achieved. In our current practice, we face difficulty in correcting more than 25° of version in young active patients with aTSA augment. Beyond this point, we perform a RTSA with an augment. In older patients or low-demand patients, we only correct minor deformities (<20°) with an aTSA augment, opting instead for an augmented RTSA due to the lower midterm failure rates observed with this implant.
