Walch A2 glenoids and degenerative shoulder arthritis. Minimal glenoid reaming

A2 glenoids according to the Walch classification are not difficult to ream because there is no deformity. However, the medial glenoid erosion is best approached with minimal reaming of the glenoid to the subchondral plate. The following case is a patient is her 70s who presented with GH joint arthritis and has failed conservative Rx. She had an intact rotator cuff and active forward shoulder elevation to 100 degrees. The surgical exposure and the preoperative and postoperative XRs are shown below. This case highlights the need of careful reaming to avoid loss of "structural support" on the glenoid side.

Loss of cartilage from humeral head and inferior osteophytes

Exposure of the glenoid

After the drilling of the holes for the central and peripheral pegs of the all polyethylene glenoid component

Implantation of the glenoid component

Placement of 6 #2 Fiberwire sutures for the repair of the subscapularis back to the lesser tuberosity

Implantation of the humeral stem and head

Postopertive Grashey view showing the height and alignment of the prosthesis

Axillary view