The glenoid in total shoulder arthroplasty

  • Mark Schrumpf
  • Travis Maak
  • Sommer Hammoud
  • Edward V. Craig
Modern Techniques in Shoulder Surgery (Lawrence V. Gulotta, Section Editor)


Management of glenohumeral arthrosis with a total shoulder prosthesis is becoming increasingly common. However, failure of the glenoid component remains one of the most common causes for failure. Our understanding of this problem has evolved greatly since the first implants were placed in the 1970’s. However glenoid failure remains a challenging problem to address and manage. This article reviews the current knowledge regarding the glenoid in total shoulder arthroplasty touching on anatomy, component design, implant fixation, causes of implant failure, management of glenoid failure and alternatives to glenoid replacement.


Total shoulder arthroplasty Glenoid component Hybrid glenoid Radiolucent lines Glenoid loosing Glenoid component failure 



M. Schrumpf: none; T. Maak: none; S. Hammoud: none; E. Craig: consultant to Biomet, Inc. for shoulder prosthesis, receives royalties from Biomet, Inc. for shoulder prosthesis.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Lugli T. Artificial shoulder joint by Pean (1893): the facts of an exceptional intervention and the prosthetic method. Clin Orthop Relat Res. 1978;133:2158.Google Scholar
  2. 2.
    Neer II CS. Articular replacement for the humeral head. J Bone Joint Surg Am. 1955;37-A(2):215–28.PubMedGoogle Scholar
  3. 3.
    Nicholson GP, Goldstein JL, Romeo AA, Cole BJ, Hayden JK, Twigg SL, et al. Lateral meniscus allograft biologic glenoid arthroplasty in total shoulder arthroplasty for young shoulders with degenerative joint disease. J Shoulder Elbow Surg. 2007;16(5 Suppl):S261–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Neer II CS, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg Am. 1982;64(3):319–37.PubMedGoogle Scholar
  5. 5.
    Cofield RH. Total shoulder arthroplasty with the Neer prosthesis. J Bone Joint Surg Am. 1984;66(6):899–906.PubMedGoogle Scholar
  6. 6.
    Gartsman GM, Roddey TS, Hammerman SM. Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis. J Bone Joint Surg Am. 2000;82(1):26–34.PubMedGoogle Scholar
  7. 7.
    Gartsman GM, Russell JA, Gaenslen E. Modular shoulder arthroplasty. J Shoulder Elbow Surg. 1997;6(4):333–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Matsen III FA. Early effectiveness of shoulder arthroplasty for patients who have primary glenohumeral degenerative joint disease. J Bone Joint Surg Am. 1996;78(2):260–4.PubMedGoogle Scholar
  9. 9.
    Norris TR, Iannotti JP. Functional outcome after shoulder arthroplasty for primary osteoarthritis: a multicenter study. J Shoulder Elbow Surg. 2002;11(2):130–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Wallace AL, Phillips RL, MacDougal GA, Walsh WR, Sonnabend DH. Resurfacing of the glenoid in total shoulder arthroplasty. A comparison, at a mean of 5 years, of prostheses inserted with and without cement. J Bone Joint Surg Am. 1999;81(4):510–8.PubMedGoogle Scholar
  11. 11.
    DePalma AF, Callery G, Bennett GA. Shoulder joint: variational anatomy and degenerative lesions of the shoulder joint. Instr Course Lect. 1949;6:255–81.Google Scholar
  12. 12.
    Checroun AJ, Hawkins C, Kummer FJ, Zuckerman JD. Fit of current glenoid component designs: an anatomic cadaver study. J Shoulder Elbow Surg. 2002;11(6):614–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Kwon YW, Powell KA, Yum JK, Brems JJ, Iannotti JP. Use of three-dimensional computed tomography for the analysis of the glenoid anatomy. J Shoulder Elbow Surg. 2005;14(1):85–90.PubMedCrossRefGoogle Scholar
  14. 14.
    Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74(4):491–500.PubMedGoogle Scholar
  15. 15.
    Sharkey NA, Marder RA. The rotator cuff opposes superior translation of the humeral head. Am J Sports Med. 1995;23(3):270–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Churchill RS, Brems JJ, Kotschi H. Glenoid size, inclination, and version: an anatomic study. J Shoulder Elbow Surg. 2001;10(4):327–32.PubMedCrossRefGoogle Scholar
  17. 17.
    Mallon WJ, Brown HR, Vogler III JB, Martinez S. Radiographic and geometric anatomy of the scapula. Clin Orthop Relat Res. 1992;277:142–54.PubMedGoogle Scholar
  18. 18.
    Saha AK. The classic. Mechanism of shoulder movements and a plea for the recognition of “zero position” of glenohumeral joint. Clin Orthop Relat Res. 1983;173:3–10.PubMedGoogle Scholar
  19. 19.
    Walch G, Boulahia A, Boileau P, Kempf JF. Primary glenohumeral osteoarthritis: clinical and radiographic classification. The Aequalis Group. Acta Orthop Belg. 1998;64 Suppl 2:46–52.PubMedGoogle Scholar
  20. 20.
    Cofield RH, Edgerton BC. Total shoulder arthroplasty: complications and revision surgery. Instr Course Lect. 1990;39:449–62.PubMedGoogle Scholar
  21. 21.
    Matsen III FA, Bicknell RT, Lippitt SB. Shoulder arthroplasty: the socket perspective. J Shoulder Elbow Surg. 2007;16(5 Suppl):S241–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Iannotti JP, Spencer EE, Winter U, Deffenbaugh D, Williams G. Prosthetic positioning in total shoulder arthroplasty. J Shoulder Elbow Surg. 2005;14(1 Suppl S):111S–21S.PubMedCrossRefGoogle Scholar
  23. 23.
    Moeckel BH, Altchek DW, Warren RF, Wickiewicz TL, Dines DM. Instability of the shoulder after arthroplasty. J Bone Joint Surg Am. 1993;75(4):492–7.PubMedGoogle Scholar
  24. 24.
    Rice RS, Sperling JW, Miletti J, Schleck C, Cofield RH. Augmented glenoid component for bone deficiency in shoulder arthroplasty. Clin Orthop Relat Res. 2008;466(3):579–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Gillespie R, Lyons R, Lazarus M. Eccentric reaming in total shoulder arthroplasty: a cadaveric study. Orthopedics. 2009;32(1):21.PubMedCrossRefGoogle Scholar
  26. 26.
    Clavert P, Millett PJ, Warner JJ. Glenoid resurfacing: what are the limits to asymmetric reaming for posterior erosion? J Shoulder Elbow Surg. 2007;16(6):843–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Williams GR, Abboud JA. Total shoulder arthroplasty: glenoid component design. J Shoulder Elbow Surg. 2005;14(1 Suppl S):122S–8S.PubMedCrossRefGoogle Scholar
  28. 28.
    Anglin C, Wyss UP, Nyffeler RW, Gerber C. Loosening performance of cemented glenoid prosthesis design pairs. Clin Biomech (Bristol, Avon). 2001;16(2):144–50.CrossRefGoogle Scholar
  29. 29.
    Collins D, Tencer A, Sidles J, Matsen III F. Edge displacement and deformation of glenoid components in response to eccentric loading. The effect of preparation of the glenoid bone. J Bone Joint Surg Am. 1992;74(4):501–7.PubMedGoogle Scholar
  30. 30.
    Anglin C, Wyss UP, Pichora DR. Shoulder prosthesis subluxation: theory and experiment. J Shoulder Elbow Surg. 2000;9(2):104–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Walch G, Edwards TB, Boulahia A, Boileau P, Mole D, Adeleine P. The influence of glenohumeral prosthetic mismatch on glenoid radiolucent lines: results of a multicenter study. J Bone Joint Surg Am. 2002;84-A(12):2186–91.PubMedGoogle Scholar
  32. 32.
    Anglin C, Wyss UP, Pichora DR. Mechanical testing of shoulder prostheses and recommendations for glenoid design. J Shoulder Elbow Surg. 2000;9(4):323–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Couteau B, Mansat P, Estivalezes E, Darmana R, Mansat M, Egan J. Finite element analysis of the mechanical behavior of a scapula implanted with a glenoid prosthesis. Clin Biomech (Bristol, Avon). 2001;16(7):566–75.CrossRefGoogle Scholar
  34. 34.
    Karduna AR, Williams GR, Iannotti JP, Williams JL. Total shoulder arthroplasty biomechanics: a study of the forces and strains at the glenoid component. J Biomech Eng. 1998;120(1):92–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Karduna AR, Williams GR, Williams JL, Iannotti JP. Glenohumeral joint translations before and after total shoulder arthroplasty. A study in cadavera. J Bone Joint Surg Am. 1997;79(8):1166–74.PubMedGoogle Scholar
  36. 36.
    Severt R, Thomas BJ, Tsenter MJ, Amstutz HC, Kabo JM. The influence of conformity and constraint on translational forces and frictional torque in total shoulder arthroplasty. Clin Orthop Relat Res. 1993;292:151–8.PubMedGoogle Scholar
  37. 37.
    Terrier A, Buchler P, Farron A. Influence of glenohumeral conformity on glenoid stresses after total shoulder arthroplasty. J Shoulder Elbow Surg. 2006;15(4):515–20.PubMedCrossRefGoogle Scholar
  38. 38.
    • Nho SJ, Ala OL, Dodson CC, Figgie MP, Wright TM, Craig EV, et al. Comparison of conforming and nonconforming retrieved glenoid components. J Shoulder Elbow Surg. 2008;17(6):914–20. This paper reaffirmed through retrieval data that conforming glenoids show greater wear.PubMedCrossRefGoogle Scholar
  39. 39.
    Strauss EJ, Roche C, Flurin PH, Wright T, Zuckerman JD. The glenoid in shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18(5):819–33.PubMedCrossRefGoogle Scholar
  40. 40.
    •• Fox TJ, Cil A, Sperling JW, Sanchez-Sotelo J, Schleck CD, Cofield RH. Survival of the glenoid component in shoulder arthroplasty. J Shoulder Elbow Surg. 2009;18(6):859–63. This paper presented good 20 year follow up data on a number of implant designs and was large enough to isolate risk factors for early loosing.PubMedCrossRefGoogle Scholar
  41. 41.
    Boileau P, Avidor C, Krishnan SG, Walch G, Kempf JF, Mole D. Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study. J Shoulder Elbow Surg. 2002;11(4):351–9.PubMedCrossRefGoogle Scholar
  42. 42.
    • Taunton MJ, McIntosh AL, Sperling JW, Cofield RH. Total shoulder arthroplasty with a metal-backed, bone-ingrowth glenoid component. Medium to long-term results. J Bone Joint Surg Am. 2008;90(10):2180–8. This paper shows the high rates of failure of metal backed designs. PubMedCrossRefGoogle Scholar
  43. 43.
    Clement ND, Mathur K, Colling R, Stirrat AN. The metal-backed glenoid component in rheumatoid disease: eight- to fourteen-year follow-up. J Shoulder Elbow Surg. 2010;19(5):749–56.PubMedCrossRefGoogle Scholar
  44. 44.
    Castagna A, Randelli M, Garofalo R, Maradei L, Giardella A, Borroni M. Mid-term results of a metal-backed glenoid component in total shoulder replacement. J Bone Joint Surg Br. 2010;92(10):1410–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Gartsman GM, Elkousy HA, Warnock KM, Edwards TB, O’Connor DP. Radiographic comparison of pegged and keeled glenoid components. J Shoulder Elbow Surg. 2005;14(3):252–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Nuttall D, Haines JF, Trail II. A study of the micromovement of pegged and keeled glenoid components compared using radiostereometric analysis. J Shoulder Elbow Surg. 2007;16(3 Suppl):S65–70.PubMedCrossRefGoogle Scholar
  47. 47.
    Szabo I, Buscayret F, Edwards TB, Nemoz C, Boileau P, Walch G. Radiographic comparison of flat-back and convex-back glenoid components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2005;14(6):636–42.PubMedCrossRefGoogle Scholar
  48. 48.
    Churchill RS, Boorman RS, Fehringer EV, Matsen III FA. Glenoid cementing may generate sufficient heat to endanger the surrounding bone. Clin Orthop Relat Res. 2004;419:76–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Kasten P, Pape G, Raiss P, Bruckner T, Rickert M, Zeifang F, et al. Mid-term survivorship analysis of a shoulder replacement with a keeled glenoid and a modern cementing technique. J Bone Joint Surg Br. 2010;92(3):387–92.PubMedCrossRefGoogle Scholar
  50. 50.
    Mileti J, Boardman III ND, Sperling JW, Cofield RH, Torchia ME, O’driscoll SW, et al. Radiographic analysis of polyethylene glenoid components using modern cementing techniques. J Shoulder Elbow Surg. 2004;13(5):492–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Norris BL, Lachiewicz PF. Modern cement technique and the survivorship of total shoulder arthroplasty. Clin Orthop Relat Res. 1996;328:76–85.PubMedCrossRefGoogle Scholar
  52. 52.
    Young AA, Walch G. Fixation of the glenoid component in total shoulder arthroplasty: what is “modern cementing technique?”. J Shoulder Elbow Surg. 2010;19(8):1129–36.PubMedCrossRefGoogle Scholar
  53. 53.
    Dines DM, Dines JS, Warren RF, Craig EV, Gulotta L. Early results of hybrid glenoid replacement in TSA for osteoarthritis. Scotland: Edinburgh; 2010.Google Scholar
  54. 54.
    Arnold RM, High RR, Grosshans KT, Walker CW, Fehringer EV. Bone presence between the central peg’s radial fins of a partially cemented pegged all poly glenoid component suggest few radiolucencies. J Shoulder Elbow Surg. 2011;20(2):315–21.PubMedCrossRefGoogle Scholar
  55. 55.
    Churchill RS, Zellmer C, Zimmers HJ, Ruggero R. Clinical and radiographic analysis of a partially cemented glenoid implant: five-year minimum follow-up. J Shoulder Elbow Surg. 2010;19(7):1091–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Kepler CK, Nho SJ, Bansal M, Ala OL, Craig EV, Wright TM, et al. Radiographic and histopathologic analysis of osteolysis after total shoulder arthroplasty. J Shoulder Elbow Surg. 2010;19(4):588–95.PubMedCrossRefGoogle Scholar
  57. 57.
    Matsen III FA, Clinton J, Lynch J, Bertelsen A, Richardson ML. Glenoid component failure in total shoulder arthroplasty. J Bone Joint Surg Am. 2008;90(4):885–96.PubMedCrossRefGoogle Scholar
  58. 58.
    Rockwood Jr CA, Wirth MA. Observation on retrieved Hylamer glenoids in shoulder arthroplasty: problems associated with sterilization by gamma irradiation in air. J Shoulder Elbow Surg. 2002;11(2):191–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Lazarus MD, Jensen KL, Southworth C, Matsen III FA. The radiographic evaluation of keeled and pegged glenoid component insertion. J Bone Joint Surg Am. 2002;84-A(7):1174–82.PubMedGoogle Scholar
  60. 60.
    Franklin JL, Barrett WP, Jackins SE, Matsen III FA. Glenoid loosening in total shoulder arthroplasty. Association with rotator cuff deficiency. J Arthroplasty. 1988;3(1):39–46.PubMedCrossRefGoogle Scholar
  61. 61.
    Farron A, Terrier A, Buchler P. Risks of loosening of a prosthetic glenoid implanted in retroversion. J Shoulder Elbow Surg. 2006;15(4):521–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Hopkins AR, Hansen UN, Amis AA, Emery R. The effects of glenoid component alignment variations on cement mantle stresses in total shoulder arthroplasty. J Shoulder Elbow Surg. 2004;13(6):668–75.PubMedCrossRefGoogle Scholar
  63. 63.
    Antuna SA, Sperling JW, Cofield RH, Rowland CM. Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg. 2001;10(3):217–24.PubMedCrossRefGoogle Scholar
  64. 64.
    Green A, Norris TR. Shoulder arthroplasty for advanced glenohumeral arthritis after anterior instability repair. J Shoulder Elbow Surg. 2001;10(6):539–45.PubMedCrossRefGoogle Scholar
  65. 65.
    Sperling JW, Antuna SA, Sanchez-Sotelo J, Schleck C, Cofield RH. Shoulder arthroplasty for arthritis after instability surgery. J Bone Joint Surg Am. 2002;84-A(10):1775–81.PubMedGoogle Scholar
  66. 66.
    Arntz CT, Matsen III FA, Jackins S. Surgical management of complex irreparable rotator cuff deficiency. J Arthroplasty. 1991;6(4):363–70.PubMedCrossRefGoogle Scholar
  67. 67.
    Hopkins AR, Hansen UN, Amis AA, Taylor M, Emery RJ. Glenohumeral kinematics following total shoulder arthroplasty: a finite element investigation. J Orthop Res. 2007;25(1):108–15.PubMedCrossRefGoogle Scholar
  68. 68.
    O’Driscoll SW, Petrie RS, Torchia ME. Arthroscopic removal of the glenoid component for failed total shoulder arthroplasty. A report of five cases. J Bone Joint Surg Am. 2005;87(4):858–63.PubMedCrossRefGoogle Scholar
  69. 69.
    Raphael BS, Dines JS, Warren RF, Figgie M, Craig EV, Fealy S, et al. Symptomatic glenoid loosening complicating total shoulder arthroplasty. HSS J. 2010;6(1):52–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Codsi MJ, Bennetts C, Gordiev K, Boeck DM, Kwon Y, Brems J, et al. Normal glenoid vault anatomy and validation of a novel glenoid implant shape. J Shoulder Elbow Surg. 2008;17(3):471–8.PubMedCrossRefGoogle Scholar
  71. 71.
    Cheung EV, Sperling JW, Cofield RH. Reimplantation of a glenoid component following component removal and allogenic bone-grafting. J Bone Joint Surg Am. 2007;89(8):1777–83.PubMedCrossRefGoogle Scholar
  72. 72.
    Scalise JJ, Iannotti JP. Bone grafting severe glenoid defects in revision shoulder arthroplasty. Clin Orthop Relat Res. 2008;466(1):139–45.PubMedCrossRefGoogle Scholar
  73. 73.
    Deutsch A, Abboud JA, Kelly J, Mody M, Norris T, Ramsey ML, et al. Clinical results of revision shoulder arthroplasty for glenoid component loosening. J Shoulder Elbow Surg. 2007;16(6):706–16.PubMedCrossRefGoogle Scholar
  74. 74.
    Clinton J, Franta AK, Lenters TR, Mounce D, Matsen III FA. Nonprosthetic glenoid arthroplasty with humeral hemiarthroplasty and total shoulder arthroplasty yield similar self-assessed outcomes in the management of comparable patients with glenohumeral arthritis. J Shoulder Elbow Surg. 2007;16(5):534–8.PubMedCrossRefGoogle Scholar
  75. 75.
    Hasan SS, Leith JM, Campbell B, Kapil R, Smith KL, Matsen III FA. Characteristics of unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg. 2002;11(5):431–41.PubMedCrossRefGoogle Scholar
  76. 76.
    Matsen III FA, Clark JM, Titelman RM, Gibbs KM, Boorman RS, Deffenbaugh D, et al. Healing of reamed glenoid bone articulating with a metal humeral hemiarthroplasty: a canine model. J Orthop Res. 2005;23(1):18–26.PubMedCrossRefGoogle Scholar
  77. 77.
    Weldon III EJ, Boorman RS, Smith KL, Matsen III FA. Optimizing the glenoid contribution to the stability of a humeral hemiarthroplasty without a prosthetic glenoid. J Bone Joint Surg Am. 2004;86-A(9):2022–9.PubMedGoogle Scholar
  78. 78.
    Burkhead Jr WZ, Krishnan SG, Lin KC. Biologic resurfacing of the arthritic glenohumeral joint: Historical review and current applications. J Shoulder Elbow Surg. 2007;16(5 Suppl):S248–53.PubMedCrossRefGoogle Scholar
  79. 79.
    Bohsali KI, Wirth MA, Rockwood Jr CA. Complications of total shoulder arthroplasty. J Bone Joint Surg Am. 2006;88(10):2279–92.PubMedCrossRefGoogle Scholar
  80. 80.
    Edwards TB, Kadakia NR, Boulahia A, Kempf JF, Boileau P, Nemoz C, et al. A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: results of a multicenter study. J Shoulder Elbow Surg. 2003;12(3):207–13.PubMedCrossRefGoogle Scholar
  81. 81.
    Krishnan SG, Nowinski RJ, Harrison D, Burkhead WZ. Humeral hemiarthroplasty with biologic resurfacing of the glenoid for glenohumeral arthritis. Two to fifteen-year outcomes. J Bone Joint Surg Am. 2007;89(4):727–34.PubMedCrossRefGoogle Scholar
  82. 82.
    Savoie III FH, Brislin KJ, Argo D. Arthroscopic glenoid resurfacing as a surgical treatment for glenohumeral arthritis in the young patient: midterm results. Arthroscopy. 2009;25(8):864–71.PubMedCrossRefGoogle Scholar
  83. 83.
    Hettrich CM, Weldon III E, Boorman RS, Parsons IV IM, Matsen FA. Preoperative factors associated with improvements in shoulder function after humeral hemiarthroplasty. J Bone Joint Surg Am. 2004;86-A(7):1446–51.PubMedGoogle Scholar
  84. 84.
    •• Elhassan B, Ozbaydar M, Diller D, Higgins LD, Warner JJ. Soft-tissue resurfacing of the glenoid in the treatment of glenohumeral arthritis in active patients less than 50 years old. J Bone Joint Surg Am. 2009;91(2):419–24. This paper clearly showed that biologic resurfacing has a high failure rate and is not the panacea for the young patient with shoulder arthrosis. PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Mark Schrumpf
    • 1
  • Travis Maak
    • 1
  • Sommer Hammoud
    • 1
  • Edward V. Craig
    • 1
  1. 1.Hospital for Special SurgeryNew YorkUSA

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