Introduction: It is generally accepted among orthopaedic surgeons that glenoid replacement is the most challenging aspect of total shoulder replacement (TSR). Surgical exposure of the glenoid is particularly difficult and access to the glenoid vault is limited. The visual cues available to guide orientation and proper placement of the glenoid component are restricted and implant malposition is a common technical error often leading to early revision. Proper position and orientation of the glenoid implant is key in order to minimize the risk of soft tissue impingement on the rim of the component and to optimize the range of motion and stability for the postoperative joint. Alignment considerations are coupled with issues regarding implant fixation. To maximize fixation, the cement must be properly pressurized in the drilled cavities to maximize contact between the cement, the porous inner surfaces of the bone cavities, and the implant. This is a challenge particular to TSR due to the complex and delicate anatomy, especially with the limited surgical exposure. If the rear wall of the glenoid is breached during preparation, then cement can be pushed through these holes during the attempted pressurization and implant insertion, rather than forced into the porous interstices of the bone surface and around the fixation pegs of the implants.
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