Moderator Thornhill: Same question to you, John. What percentage of retroversion will you tolerate? And does the depth of the glenoid vault have any indication?
Dr. Sperling: I make a lot of intraoperative decisions including to go from the anatomic to reverse. Patients are consented for both. I look at the condition of the rotator cuff with my eyes, how much glenoid bone loss is there and what’s their pre-operative function. If on the pre-operative X-ray the head is subluxed 70 to 80% posteriorly and I have more than 20-25 degrees of retroversion, then reverse arthroplasty.
Moderator Thornhill: Okay, so you’re talking about subluxation, posterior subluxation of the humeral head in association with it. I have a total shoulder. I have a standard. I thought it was a very easy operation to get better from. And you said it was harder than a reverse. I think it really depends on the status of the rotator cuff. My cuff was fine. I found it very easy…why do you say it’s a harder operation?
Dr. Sperling: We used to tell patients, “Don’t come back and have your shoulder replaced until you can’t take it anymore.” I think our mindset on that is shifting. Once I start seeing people with glenoid bone loss, I do tell them to a degree you are starting to burn some bridges that way. We are shifting in how we think and how we counsel our patients. One of the most common problems that I see is really significant glenoid bone loss.
Dr. Jobin: I think with massive bone loss, you have to start thinking outside the box and either you’re structurally grafting or using a special implant that John showed with a metal augmentation to correct version. We don’t know the long-term outcome of putting a reverse baseplate in a retroverted position. And it may be detrimental.
Moderator Thornhill: This was a great debate. Let’s thank our presenters.
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