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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2019; 60(02): 058-066
DOI: 10.1055/s-0039-1694017
Review Article | Artículo de Revisión
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Morfologia Glenoidea En La Artrosis Glenohumeral Primaria: Factores Preoperatorios Relevantes

Glenoid Morphology in Primary Glenohumeral Osteoarthritis; Preoperatory Relevant Elements
Nicolás Moran 
1   Equipo de Artroscopia de Extremidad Superior y Cirugía de Hombro, Hospital del Trabajador de Santiago, Santiago, Chile
,
Valentina Arias 
2   Médico Cirujano, Universidad de Los Andes, Santiago, Chile
,
José Lazo
3   Residente Ortopedia y Traumatología, Hospital del Trabajador, Universidad de Chile, Santiago, Chile
,
Patricio Melean
4   Cirujano de Hombro, RedSalud Santiago y Vitacura, Santiago, Chile
› Institutsangaben
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Publikationsverlauf

06. Juli 2018

24. Juni 2019

Publikationsdatum:
08. August 2019 (online)

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Resumen

El objetivo primario de esta revisión es realizar una actualización de los conceptos básicos relacionados a los cambios morfológicos glenoideos durante la artrosis glenohumeral primaria, métodos de medición relevantes y describir las modificaciones en la nueva clasificación de Gilles Walch.

La medición de esos parámetros influyen en forma directa tanto en el acto quirúrgico dentro una prótesis de hombro como en los resultados clínicos post operatorios.

Los diferentes métodos de medición descritos en la literatura han permitido evaluar la magnitud de esos fenómenos morfológicos y describir la “glenoides bicóncava”, caracterizada por presentar 3 subtipos: la paleoglena, neoglena y la glena intermedia.

A partir de esos conceptos, Walch en 1999 describe la clasificación de los cambios morfológicos glenoideos en artrosis primaria, la cual ha presentado una reciente modificación debido a la mala concordancia intra e interobservador de esa medición obtenida por varios investigadores, además de reconocer una carencia en la precisión para describir cada subtipo.

A la fecha, diferentes autores investigan la influencia de esos factores morfológicos preoperatorios en los resultados post operatorios, y hasta que valor límite podrían guiar un tratamiento especifico.

Conclusión Enfatizamos que un análisis acabado y minucioso de la morfología glenoidea es importante para una adecuada planificación quirúrgica en artroplastia de hombro, ya que eso puede guiarnos en cuál técnica o implante puede ser el más adecuado para cada tipo de glenoides.

Abstract

The main purpose of this review is to up date the basic concepts regarding the glenoid morphological changes in primary glenohumeral osteoarthritis, relevant measuring methods, and a description of the modifications in the Gilles Walch classification.

The measurement of these parameters influences both surgical indications for total shoulder arthroplasty and the post op clinical outcomes.

The different measuring methods described in literature have allowed to evaluate the magnitude of these morphological phenomena describing the “biconcave glenoid”, which characteristically presents 3 subtypes: paleoglenoid, neoglenoid and intermediate glenoid.

Based on these concepts, Walch classified the glenoid morphological changes in primary ostheoarthritis in 1999, which has been recently modified due to the poor inter-observer and intra-observer reliability described by a vast number of researchers, and also because of an observed lack of precision when describing each sub-type.

Up to date, different authors are debating the influence of these pre operative morphological factors on the post op outcomes; and the cut-off value up to which this could lead to a specific treatment.

As a conclusion, we emphasize that a deep and thorough analysis of the glenoid morphology is important for an adequate surgical planning of a shoulder arthroplasty, as this can guide us to the most adequate technique and type of implant for each type of glenoid.

Palabras clave

artrosis glenohumeral - prótesis total de hombro - desgaste glenoideo - glenoides biconcave - subluxación posterior - versión glenoidea

Keywords

glenohumeral osteoarthritis - total shoulder replacement - glenoid wear - biconcave glenoid - posterior glenohumeral subluxation - glenoid version
 

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