02/04/2026
How do you feel when you see a shoulder with 34 degrees of retroversion?
Treatment for a shoulder with severe arthritis and altered alignment may have limitations when using standard implants and approaches. There is a risk of limited baseplate fixation, excessive medialization with “high-side” reaming to correct the glenoid version, and a surgeon could consider reconstruction with posterior bone grafting—which can be challenging and time consuming to do.
This patient had a Walch B2 glenoid with 34 degrees of retroversion, rotator cuff weakness, and was > 70 years old. Research shows that RSA in patients >70 will likely offer similar patient reported outcomes to an anatomic TSA but without the risk of the polyethylene glenoid component loosening. RSA implants were chosen for the reconstruction.
3D preoperative planning demonstrated decentering of the humeral head relative to Friedman’s line and the extent of glenoid bone loss. A full wedge augmented baseplate was selected to address the severe retroversion and partially correct retroversion. The augmented component was bone preserving and avoided the need for bone graft. The glenoid side lateralization (8 mm) helped restore deltoid tension without excessive distalization or lateralization relative to the acromion. Other options include a 3D printed baseplate or posterior bone graft. The rehab program started right away with a focus on early passive ROM.
At six months postop, the patient achieved an excellent outcome with a SANE score above 95, excellent range of motion as seen in the photos, and high satisfaction.
The last image that highlights the location of the “wedge” of the glenoid baseplate—it helps compensate for the posterior bone loss and avoided the need for a posterior bone graft.
During fellowship at the Orlando Health Jewett Orthopedic Institute, fellows regularly see complex shoulder cases like this one which reinforce the importance of thoughtful planning, accurate surgery, quality PT, and regular exercises at home (or in the gym).
