Risks of loosening of a prosthetic glenoid implanted in retroversion

Osteoarthritis of the shoulder is frequently associated with posterior glenoid wear, which may be difficult to correct during shoulder arthroplasty. This study was designed to evaluate the risks that a prosthetic glenoid implanted in retroversion will loosen. The scapula, the humerus, the rotator cuff, and a total shoulder prosthesis were reconstructed with a 3-dimensional finite element model. The glenoid was placed in 5 different angles of retroversion (0°, 5°, 10°, 15°, and 20°). Location of the glenohumeral contact point, articular pressure, bone and cement stress, and micromotion around the glenoid implant were calculated during internal and external rotation. Glenoid retroversion induced a posterior displacement of the glenohumeral contact point during internal and external rotation, inducing a significant increase of stress within the cement mantel (+326%) and within the glenoid bone (+162%). Furthermore, a major increase of micromotion was measured at the bone-cement interface (+706%). According to this study, glenoid retroversion exceeding 10° should be corrected during total shoulder arthroplasty. If the correction is impossible, not replacing the glenoid should be considered.