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Learn more about our innovative shoulder fracture solutions, arthroplasty implants, preoperative planning software, moldable antibiotic spacers, and more. 

Also visit our updated <a href="https://arthroplasty-narrative-home.webflow.io/patient-resource-kit " data-new-window="true" target="_blank" rel="noopener noreferrer">patient outreach and education page</a> to enhance your clinic resources.

AAOS 2025 Annual Meeting: Shoulder Arthroplasty and Fracture Feature Products

Arthroplasty Shoulder

This Virtual Implant Positioning™ (VIP™) system release includes the ability to simulate implant selection and positioning to compare range of motion for up to 3 reverse total shoulder implant constructs, remove potential bony impingements using the osteophyte removal tool, and digitally isolate the metallic components present in your patient's anatomy with the new metal segmentation feature.

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video

Animations demonstrating the features and benefits of a specific product.

Animationen, die die Funktionen und Vorteile eines bestimmten Produkts demonstrieren.

Produktdemonstrationen

Animações demonstrando os recursos e benefícios de um produto específico.

Vídeos de demonstração de produtos

Animaciones que demuestran las características y beneficios de un producto específico.

Videos de demostración de productos

Product Demonstrations

Now Available in the VIP™ System: Range of Motion, Osteophyte Removal, and Metal Segmentation

Brian C. Werner, MD (Charlottesville, VA), highlights the value and techniques of using the latest features of the Virtual Implant Positioning™ system in total shoulder arthroplasty patients, including range of motion, osteophyte removal, and multi-plan approval.&nbsp;

A video of a live presentation reviewing Arthrex products or techniques.

Video einer Live-Präsentation, die Arthrex Produkte oder Techniken überprüft.

Präsentationsvideos

Vídeo de apresentação ao vivo analisando produtos ou técnicas da Arthrex.

Apresentação vídeos

Video de presentación en vivo que revisa los productos o técnicas de Arthrex.

Video presentaciones

Presentation Videos

VIP™ Vision: Episode 10—Overview of Range of Motion, Osteophyte Removal, and Multi-Plan Approval Features

Patrick J. Denard, MD (Medford, OR), highlights recent publications that have impacted his step-by-step approach to preoperatively planning complex reverse total shoulder cases.&nbsp;

VIP™ Vision: Episode 9—Research-Based Algorithm for RSA Planning

Welcome to VIP vision. I'm Patrick Denyer from Medford, Oregon. I want to share with you my research based algorithm for planning in RSA. So I'm going to share with you how I use the VIP system to plan RSA. Vip system is a web based platform. It's very data driven. There's lots of information on this particular platform, and one of the highlights is a reusable guide, which allows reduced cost and time to execution from plan to implementation in the operating room. And that's coupled with depth of instrumentation as well. So I'm going to go through my steps in planning for reverse shoulder arthroplasty. First of all, I like to assess the deformity. Secondly, I want to size the sphere. My next step is to determine the base plate position. Then I assess base plate contact and reaming. With that position I will augment as needed from there. Lastly, I do central fixation and screw length and then move on to humeral planning. Okay, so my first step is to assess the deformity. I like to just get a big picture here of what's going on. Really I want to see the forest for the Trees. Look at my x rays if I have those available. If I don't have those x rays available. A nice trick is to go to the original views, remove the implants, and assess the deformity. Here you can see I have a B2 glenoid. So I have posterior erosion of the glenoid with posterior subluxation the humeral head. This is going to drive me to a reverse arthroplasty. In this particular case, it will also give me a sense of the superior deformity I'm dealing with. Next I'm going to size the sphere. My primary goal here is to avoid anterior overhang of the glenoid sphere. We have a couple of studies now, both looking at the axillary view and at the sagittal wide view, which show that if we have anterior overhang we limit internal rotation. So in particular I like to size from anterior to posterior to avoid that overhang because we really want to maximize internal rotation. So you'll see here I'm going to look at this from a couple of regards. First off I'm going to look at the axial view on the bottom left. And then secondly I'm going to look at this white outline on the three dimensional view. And here we can see the 36 will overlap. So I'm going to go down to a 33. Next I'm going to position the base plate. I have three goals here I want to restore the joint line. I want to avoid superior tilt. And I want to avoid glenoid overhang. Okay. Again I'm going to avoid it anteriorly. But here I'm going to avoid overhanging in particular inferior. So I want to restore the joint line I'll try to use my normal anatomic landmarks the paleo glenoid. In this case I want to avoid superior tilt of the base plate to maximize fixation, but it's important to remember that normal superior inclination is about ten degrees. And I'll show you how I address that in this case. And then I'm going to avoid inferior glenoid overhang because that increases the risk of stress fracture. For every millimeter increase of inferior overhang the risk of stress fracture goes up in our data. So first here you see I'm going to look at version I'm looking at version in the lower left. And I'm going to set that so that it that it goes out mats and centering point right out the anterior vault. I'm aiming for that point more than I'm aiming for, actually going for an absolute number, because normal version is about seven degrees. And my primary goal here, aside from restoring the joint line, is to get fixation. And my fixation will be maximized by going out to that point. Once I have version set, looking at where I want the base plate. The next thing I'll do is address inclination. And here you can see we have seven degrees of inclination. And I'm going to set that at four degrees. That'll just give me a couple of degrees of inferior tilt. So I want to avoid superior tilt. But I have in my mind that normal superior tilt is about ten degrees. So we're respecting that or slightly correcting that in this case. And you also notice that I'm avoiding inferior overhang. I have just a little bit of overlap on this white circle. But I'm not destabilizing dramatically because if I destabilize again, that's where I'm going to increase the risk of stress fracture. And at this point, I'm not really medicalizing I'm just setting where the base plate is going to go. The next step is to assess base plate contact and depth of ream. Now I have two goals here. I want to get 75 to 100% contact. What do I mean by that? If I have a central screw, 75% is probably acceptable. The data on AugMend says that 75 to 100% should be your goal. So I'm going to go for that type of contact. I'm going to try to do this with avoiding reaming. Now there's not set guidelines for reverse shoulder arthroplasty. But we know the depth of subchondral bone is about 3.5mm. So when we reverse we have a little more tolerance. And I want to minimize my reaming to less than five millimeters. So I picked the position of where I want my base plate first. I can adjust lateral and medial. And then from there I can check my max GAP offset. In this case it's 6.5mm. And you can see that my seating Ceiling is only 16%. Now, I know that a ten degree argument will reestablish about four millimeters of the joint line, but a 20 degree argument will reestablish almost nine millimeters of the joint line in the back of the implant. So that's what I'll be picking in this case, because I want to fill that up. That's where I'm going to augment as needed to really get that maximum contact. Now my goals here are to get long, superior and inferior screws. And I want to do that by having proper orientation of my AugMend because we have two options. We have a standard AugMend which is designed for superior deformity, which will go along superior and inferior screws. And then for a posterior deformity, as in this case, I'll use an oblique augment, which slightly clocks the implant more posterior and provides long, superior and inferior screws. So here I'll move from a standard MDS base plate to a full augment. I'm going to go up to the 20 degree oblique. And then I can apply lateralization if desired because I can lateralize two millimeters on the base plate, and then I can lateralize four millimeters on the sphere at maximum. So I first of all restore the joint line. And then I can go out lateral from there. And here you can see once I do that my contact has increased to 96%. So in this case I think that will be very acceptable for fixation. Next I want to do central fixation and get my screw length okay. My goal here is to go bicortical with central fixation. Data shows both with a post and with a central screw. That implant fixation is improved at time zero by going bicortical. My second main goal is to get a long inferior screw screw. Length is important for fixation, and that's really important when we're going lateral, because we place more force on the base plate and the inferior screw is most important. I want to get screws anterior and posterior as well, but I want to particularly avoid violating the scapular spine or suprascapular notch with my superior screws. So I'm typically going to go with a bicortical locking screw up top. So here you see on the axial view down here I can adjust my central post. If I go down to a 25 I'm going to be contained. A 35 is a bit too long, but a 30 is nice and bicortical. Next I'll look at my peripheral screws and I'm going to adjust here. Typically it's a 36 inferior sometimes a little bit longer. Once I have that into place this will be a non-locking screw that I will place first. I will then select locking screws in the other locations. Anywhere from a 16 to 20 anterior and posterior is typical. And then superiorly you can see here I'm looking at the suprascapular notch. If we sometimes have a long screw, we can go toward that notch. And you can see before as well that I was avoiding going toward the scapular spine. When I'm placing my base plate with an augmented implant, I really like to have a single compression screw first. You do get compression when you get impaction of the base plate, but I like to get additional compression with a non-locking screw, as I said inferiorly, and then I will lock in after that. The other thing that I really like doing this for is that this will improve my efficiency. So not only have I selected my implants, but during the surgery, I can pull my screws and have those ready to go, which really saves me a lot of time in the operating room. So a couple of minutes here will save me several minutes in the operating room of waiting. The last step is humeral planning. This is a newer feature in reverse shoulder arthroplasty. My primary goal here is simple. That's to get an inlay humeral cup. Why is that? We talked about distalization on the glenoid side, but on the humeral side. There is good data that shows that if you have inlaid humeral cup, you have less distalization. And that again lowers the risk of stress fracture. Post-operatively. In one study that we did, the risk of stress fracture was much higher, almost three times higher with an onlay compared to an inlay. So I'm going to go with a 135 implant. I like to look at the inner circle. As you can see that's also valuable for anatomic. And I can adjust my cut up and down and then select the appropriate stem size. So I'll see here where I want to make my cut. Looking at the anatomic landmarks. And I can select my stem size from there. In our early data that's not published. We found that we're typically within one stem size. So again I have a lot of improved efficiency by knowing what the potential size is going in. And I can go back and forth between the standard stem or a short stem based on what fits the best for this particular patient. In this case, that's a standard length stem size five, and I can save my plan and be ready to go to the operating room. Thank you.

This animation shows the glenoid targeter calibration steps for the 3D and 5D transfer devices for the Arthrex® VIP™ system.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

Virtual Implant Positioning™ (VIP) Transfer Instrumentation

application/pdf

A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

Kataloge

Visão geral e abrangente do portfólio de produtos de cada segmento.

Catálogos

Descripción general y completa sobre la cartera de productos de cada segmento. 

Catalogs

Arthroplasty and Shoulder Fracture - Next Generation in Repair and Reconstruction

This animation presents the features and benefits of the Univers Revers™ humeral implants.

Univers Revers™ Total Shoulder System—Versatility. Simplicity. Performance.

The Univers Apex OptiFit™ total shoulder system stem features in situ anatomic reconstruction, stable bony fixation with a midsize stem length and proximal titanium plasma spray, a removable trunnion for optimal revisability, and strategic suture holes for secure subscapularis repair.

Univers Apex OptiFit™ Optimized Anatomic Arthroplasty

Three years after shoulder replacement surgery, former major league pitcher Dave Dravecky is still enjoying his active lifestyle thanks to the Eclipse™ total shoulder system and the hands of a great surgeon. Visit <a href="https://www.shoulderreplacement.com" data-new-window="true" target="_blank" rel="noopener noreferrer">ShoulderReplacement.com</a> to watch the first part of his story and to learn more about overcoming shoulder pain.

Patient feedback on their experience with Arthrex techniques.

Feedback von Patient:innen über ihre Erfahrungen mit Arthrex Techniken.

Erfahrungsberichte von Patient:innen

Comentários de pacientes sobre suas experiências com as técnicas Arthrex.

Testemunhos de pacientes

Comentarios de pacientes sobre su experiencia con las técnicas de Arthrex.

Testimonios de pacientes

Patient Testimonials

Former Pro Baseball Player With the Eclipse™ Total Shoulder System: 3-Year Follow-Up

This animation provides an overview of the FxBridge™ tuberosity repair system and the surgical technique used in conjunction with Univers Revers™ implants to treat proximal humeral fractures.

FxBridge™ Tuberosity Repair System: Reverse Total Shoulder Arthroplasty

Identify the proximal humeral fracture pattern. The humeral head fragment is removed from the wound. Begin the repair by passing the blue number two FiberLink inside out through the infraspinatus tendon at the bone tendon junction. Repeat this process with the white black number two. Tigerlink going through the inferior portion. Next, pass the number two FiberLink inside out through the superior portion of the subscapularis tendon. Repeat this process with the number two TigerLink through the inferior portion. Prepare the glenoid per the specific glenoid system surgical technique being used. Then prepare and trial the humeral components. Remove the humeral trials and drill two holes in the lateral side of the bicipital groove with the 2.0mm drill bit. Drill the holes 1 to 2cm distal to the humeral shaft. Fracture line. Pass the black blue 1.7mm FiberTape in an outside in, then inside out fashion. Repeat this with a second 1.7mm FiberTape. After assembling the suture cup and humeral stem, Pass the white black 1.7mm TigerTape through the two distal row eyelets of the SutureCast. Then pass the blue 1.7mm FiberTape through the proximal two eyelets. Repeat the suture passing for the posterior eyelets. Implant the humeral prosthesis and place the final humeral insert on the posterior side. Take the suture tails from the blue FiberTape and feed them into the blue FiberLink looped end. Repeat the previous steps for the TigerTape and TigerLink, then shuttle the sutures through the greater tuberosity. Reduce the shoulder on the anterior side. Take the suture tails from the blue FiberTape and feed them into the blue FiberLink looped end. Repeat the previous steps for the TigerTape and TigerLink. Shuttle the suture through the subscapularis. Take one limb of the blue FiberTape from the lesser tuberosity, and one limb of the blue FiberTape from the greater tuberosity, and tie them together. Note the strands are free moving and won't tension when being tied together. Take one limb of the white black TigerTape from the lesser tuberosity and one limb of the white black TigerTape from the greater tuberosity and tie them together. Take the remaining blue FiberTape from the lesser tuberosity and the remaining white black TigerTape from the greater tuberosity, and tie them together. These remaining strands allow for the construct to be tensioned when tied. Take the remaining white black TigerTape from the lesser tuberosity, and the remaining blue FiberTape from the greater tuberosity, and tie them together after the suture construct has been tied. Pass and tie the vertical tension band sutures starting with the anterior whole. Pass one limb of the black blue FiberTape up through the superior aspect of the subscapularis, and then through the superior aspect of the infraspinatus. Take one limb of suture from the posterior whole and tie it to the past suture. Repeat the process for the remaining black blue FiberTape working posterior to anterior.

This animation illustrates the features and benefits of the Eclipse™ total shoulder arthroplasty system.

Eclipse™ Total Shoulder Arthroplasty System: Features and Benefits

Shoulder

This animation demonstrates subscapularis repair in anatomic total shoulder arthroplasty using the Eclipse™ SpeedScap™ technique and trunnion adapter.

Eclipse™ SpeedScap™ Subscapularis Repair

Eclipse. Speedscap repair is a knotless double row method used in conjunction with the subscapularis peel for anatomic total shoulder arthroplasty. After preparation of the humerus, including humeral head osteotomy and trunnion and cage screw sizing. The final trunnion is guided over the centering device and slotted into place. The cage screw is then inserted until the final fixation is achieved. The Eclipse trunnion adapter is placed onto the trunnion, appropriately sized to the implanted cage screw length. This provides an outline of the cage screw so it can be avoided during both medial and lateral row humeral anchor. Preparation. The medial row of the repair is completed by placing three FiberTak Dr anchors in the appropriate position to maximize native subscapularis footprint contact on the lesser tuberosity. The trunnion adapter can be rotated as needed to optimize anchor position and avoid the cage screw. The short FiberTak Dr drill is used to prepare the humerus for anchor insertion. The drill is kept parallel or divergent to the trunnion adapter to ensure the drill tip will not contact the cage screw. After drilling, insert a FiberTak Dr anchor, remove the driver and set the anchor FiberWire suture can be removed from the anchor or retained for use later in the repair. Using the drill for the 3.9mm SwiveLock anchor. Prepare two holes adequately spaced to cover the native subscapularis footprint on the lesser tuberosity. After all medial row anchors are placed, pass each limb of LabralTape in sequential fashion and appropriately spaced through the tendon of the subscapularis, ensuring to remain lateral to the musculotendinous junction. Secure one limb from each FiberTak Dr. Anchor three altogether, and insert through the eyelet of a 3.9mm SwiveLock anchor. Finalize tension of the LabralTape suture prior to inserting the eyelet into the prepared socket. This completes the knotless double row Eclipse SpeedScap repair.

Trauma Upper Extremities

The Proximal Humerus Plating System provides three distinct plate offerings for treating a variety of fracture patterns. The ALPHA plate incorporates side-specific anatomic contours that helps spare the deltoid attachment site and a crossing screw pattern proximally. The system also features the 95° greater tuberosity buttress plate and the 130° PHP for limiting subacromial impingement.

Proximal Humerus Plating System

The Arthrex proximal humerus plating system is intended to treat a variety of fractures of the proximal humerus. The system features the alpha anatomic plate, 95 degree buttress plate, and the 130 degree proximal humeral plate. The alpha plate is a unique, site specific, anatomically designed option featuring crossing screws for increased screw length in the humeral head, suture holes for cuff repair, a choice of 4.0mm fully or partially threaded, locking screws proximally, and interior bend to avoid the deltoid insertion site, an oblong hole that allows up to five millimeters of compression and accepts 3.5mm locking or non-locking screws in the shaft. The blue and yellow color coded screw configurations can be used interchangeably proximally, while the green and gray screws are interchangeable distally. Begin the procedure by positioning the plate on the bone with the alignment guide attached. Using the 2.8mm multiple drill guide, drill bicortical through the slotted hole with the 2.8mm calibrated drill bit. Using the laser markings on the drill to determine screw length, insert a non-locking screw through the hole using a t15 driver and handle. Verify the proximal screw trajectory by inserting K-wires through the aiming block and verifying using fluoroscopy. Insert the screw sheath into the alignment guide followed by the 3.5mm drill guide. Advance the 3.5mm step. Drill through the sleeve until the drill tip reaches subchondral bone. Unthread and remove the drill guide from the sleeve using the depth guide. Measure to determine the desired screw length to be inserted. Insert a 4.0mm partially threaded locking screw through the sleeve. Repeat the steps for the for the remaining proximal screws. The choice of fully or partially threaded 4.0mm screws is based on surgeon preference. Once all proximal screws are inserted, remove the alignment guide for the distal holes. Begin by threading the 2.8mm locking drill tower into the screw hole. Drill bicortical using the 2.8mm drill, and use the calibration lines on the drill bit to determine screw depth. Unthread and remove the locking drill tower and insert a 3.5mm locking screw using the hex driver. Repeat the previous steps to fill the remaining holes with 3.5mm screws to complete the plate. Fixation SutureLasso technology allows for repair of the rotator cuff to the plate after the plate is applied.

A list of scientific articles pertaining to a product or procedure.

Eine Liste wissenschaftlicher Artikel zu einem Produkt oder Verfahren.

Wissenschaftsupdate

Lista de artigos científicos referentes a um produto ou procedimento.

Atualizações científicas

Lista de artículos científicos relacionados con un producto o procedimiento.

Actualizaciones científicas

Scientific Updates

Publication List 2024 Pak T, Ardebol J, Kilic AI, et al Shah A, Werner B, Gobezie R, Posteroinferior glenosphere positioning is associated with improved range of motion following reverse shoulder arthroplasty with a 135° inlay humeral component and lateralized glenoid. J Shoulder Elbow Surg. 2024 Mar 25:S1058-2746(24)00219-2. Epub ahead of print. doi:10.1016/j.jse.2024.02.019 Quantifying bone loss and lateralization with standardized baseplate vs augmented baseplates. JSES Int. Published online May 6, 2024. doi:10.1016/j.jseint.2024.04.014 et al Sears BW, Denard PJ, Lederman E, Gobezie R, Limited preoperative forward flexion does not impact outcomes between anatomic or reverse shoulder arthroplasty for primary glenohumeral arthritis. Semin Arthroplasty. Published online May 3, 2024. doi:10.1053/j.sart.2024.03.007 Werner BC Erickson BJ, Denard PJ, Gobezie R, Seasonal timing of surgery does not affect clinical outcomes in total shoulder arthroplasty. Semin Arthroplasty. Published online May 8, 2024. doi:10.1053/j.sart.2024.03.015 Lederman E, Sears B, Werner BC Ritter D, Denard PJ, Raiss P, Wijdicks CA, A stemless anatomic shoulder arthroplasty design provides increased cortical medial calcar bone loading in variable bone densities compared to a short stem implant. JSES Int. Published online February 27, 2024. doi.org/10.1016/j.jseint.2024.02.008 Bachmaier S Wittmann T, Denard PJ, Werner BC, Raiss P Pak T, Menendez ME, Gobezie R, Sears BW, Glenoid lateralization in reverse shoulder arthroplasty: metal versus bone offset in different implant designs. JSES Int. Published online February 27, 2024. doi.org/10.1016/j. jseint.2024.02.006 Rates of subacromial notching are low following reverse shoulder arthroplasty with a 135° inlay humeral component and a lateralized glenoid. JSES Int. 2024;8(3):522-527. doi. org/10.1016/j.jseint.2024.01.009 Lederman E, ShARC Klosterman EL, Tagliero AJ, Lenters TR, et al The subcoracoid distance is correlated with pain and internal rotation after reverse shoulder arthroplasty. JSES Int. 2024;8(3):528-534. doi.org/10.1016/j.jseint.2024.01.010 Ritter D, Denard PJ, Raiss P, Wijdicks CA, Preoperative 3D computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty. J Shoulder Elbow Surg. 2024;S1058-2746(23)00887-X. doi:10.1016/j.jse.2023.11.005 Bachmaier S Pak T, Ardebol J, Menendez ME, et al Oak SR, Horinek JL, Barras LA, et al Robert H. Cofield, MD, Award for Best Oral Presentation 2023: up to 8 mm of glenoidsided lateralization does not increase the risk of acromial or scapular spine stress fracture following reverse shoulder arthroplasty with a 135° inlay humeral component. J Shoulder Elbow Surg. 2024;S1058-2746(24)00019-3. doi:10.1016/j.jse.2023.11.018 Assessment of a novel computed tomography ratio to characterize B2 glenoid morphology with total shoulder arthroplasty. Semin Arthroplasty. 2024;34(1):P252-P258. doi:10.1053/j. sart.2023.04.016 2023 Stewart BP, Hawthorne BS, Dorsey CG, Wellington IJ, Reverse shoulder arthroplasty patients younger than 60 years old exhibit lower clinically significant Single Assessment Numeric Evaluation (SANE) scores compared to older patients. Cureus. 2023;15(10):e46492. doi:10.7759/cureus.46492 Cote M, Mazzocca A Werner BC, Lin A, Lenters TR, et al Werner BC, Burrus MT, Denard PJ, Influence of backside seating parameters and augmented baseplate components in virtual planning for reverse shoulder arthroplasty. Shoulder Elbow Surg. 2023:S10582746(23)00851-0. doi:10.1016/j.jse.2023.10.024 Stemless anatomic total shoulder arthroplasty is associated with less early postoperative pain. JSES Int. 2023;8(1):197-203. doi:10.1016/j.jseint.2023.10.012 et al Hwang S, Werner BC, Provencher M, et al Shah A, Galal Y, Werner BC, Gobezie R, Short-term functional outcomes of reverse shoulder arthroplasty following three-dimensional planning is similar whether placed with a standard guide or patient-specific instrumentation. J Shoulder Elbow Surg. 2023;32(8):1654-1661. doi:10.1016/j.jse.2023.02.136 Obesity is associated with improvement in functional outcome but lowers internal rotation after reverse shoulder arthroplasty. JSES Int. 2023;8(1):147-151. doi:10.1016/j. jseint.2023.08.021 Denard PJ, Lederman E Shah A, Galal Y, Lederman E, et al Humeral osteophyte size and clinical outcomes after anatomic total shoulder arthroplasty. Semin Arthroplasty. 2023;33(1):141-147. doi:10.1053/j.sart.2022.09.003 2022 Wellington IJ, Davey AP, Cote MP, Substantial clinical benefit values demonstrate a high degree of variability when stratified by time and geographic region. JSES Int. 2022;7(1):153-157. doi.org/10.1016/j.jseint.2022.10.003 et al Harmsen SM, Robaina J, Campbell D, Denard PJ, Does lateralizing the glenosphere center of rotation by 4 mm decrease scapular notching in reverse shoulder arthroplasty with a 135° humeral component? JSES Int. 2022;6(3):442-446. doi:10.1016/j.jseint.2021.12.005 Gobezie R, Lederman ES Burrus MT, Griffin JW, Denard PJ, Anatomic total shoulder arthroplasty for patients with preserved preoperative motion. Semin Arthroplasty. 2022;32(2):258-264. doi:10.1053/j.sart.2021.09.009 Lederman E, Gobezie R, Werner BC Werner BC, Denard PJ, Tokish JM, The addition of preoperative three-dimensional analysis alters implant choice in shoulder arthroplasty. Shoulder Elbow. 2022;14(4):378-384. doi:10.1177/1758573221989306 et al Muench LN, Otto A, Kia C, et al Bercik MJ, Werner BC, Sears BW, Gobezie R, Rotational range of motion of elliptical and spherical heads in shoulder arthroplasty: a dynamic biomechanical evaluation. Arch Orthop Trauma Surg. 2022;142(1):67-76. doi:10.1007/ s00402-020-03587-0 A comparison of central screw versus post for glenoid baseplate fixation in reverse shoulder arthroplasty using a lateralized glenoid design. J Clin Med. 2022;11(13):3763. doi:10.3390/ jcm11133763 Lederman E, Denard PJ Creighton RA, Burrus MT, Werner BC, Gobezie R, Short-term clinical and radiographic outcomes of a hybrid all-polyethylene glenoid based on preoperative glenoid morphology. J Shoulder Elbow Surg. 2022;31(12):2554-2561. doi:10.1016/j.jse.2022.05.016 Lederman E, Denard PJ Sears BW, Creighton RA, Denard PJ, et al Kirloskar KM, Szakiel PM, Gruber MD, Werner BC, Denard PJ Stemless components lead to improved radiographic restoration of humeral head anatomy compared with short-stemmed components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2022;S1058-2746(22)00683-8. doi:10.1016/j.jse.2022.07.024 The influence of preoperative rotator cuff cross-sectional area and strength on postoperative outcomes in reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2022;31(11):2274-2280. doi:10.1016/j.jse.2022.04.003 Erickson BJ, Denard PJ, Griffin JW, Gobezie R, Initial and 1-year radiographic comparison of reverse total shoulder arthroplasty with a short versus standard length stem. J Am Acad Orthop Surg. 2022;30(14):e968-e978. doi:10.5435/ JAAOS-D-21-01032 Lederman E, Werner BC Erickson BJ, Denard PJ, Griffin JW, et al Goodloe JB, Denard PJ, Lederman E, Gobezie R, A 135° short inlay humeral stem leads to comparable radiographic and clinical outcomes compared with a standard-length stem for reverse shoulder arthroplasty. JSES Int. 2022;6(5):802-808. doi:10.1016/j.jseint.2022.05.003 No difference in range of motion in reverse total shoulder arthroplasty using standard or constrained liners: a matched cohort study. JSES Int. 2022;6(6):929-934. doi:10.1016/j. jseint.2022.07.004 Werner BC Oak SR, Kobayashi E, Gagnier J, et al Griffin JW, Werner BC, Lederman E, et al Erickson BJ, Chalmers P, Shishani Y, Romeo AA, Patient reported outcomes and ranges of motion after reverse total shoulder arthroplasty with and without subscapularis repair. JSES Int. 2022;6(6):923-928. doi:10.1016/j. jseint.2022.07.009 Lesser tuberosity osteotomy does not appear to compromise fixation or function compared with peel in short-stem anatomic shoulder arthroplasty. Orthopedics. 2022;45(3):151-155. doi:10.3928/01477447-20220128-10 Can the reverse total shoulder arthroplasty provide as good of an outcome as an anatomic shoulder arthroplasty. Semin Arthroplasty. 2022;32(4):850-855. doi:10.1053/j. sart.2022.04.013 Lederman ES, Gobezie R Burrus MT, Denard PJ, Lederman E, Gobezie R, The influence of computed tomography preoperative planning on clinical outcomes after anatomic total shoulder arthroplasty: a matched cohort analysis. Semin Arthroplasty. 2022;32(4):856-862. doi:10.1053/j.sart.2022.04.011 Werner BC Erickson BJ, Werner BC, Griffin JW, et al A comprehensive evaluation of the association of radiographic measures of lateralization on clinical outcomes following reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2022;31(5):963-970. doi:10.1016/j.jse.2021.10.010 2021 Burrus MT, Denard PJ, Lederman E, Gobezie R, Reverse total shoulder arthroplasty for patients with preserved active elevation and moderate-to-severe pain: a matched cohort study. JSES Int. 2021;6(1):1-6. doi:10.1016/j. jseint.2021.10.004 Werner BC Berthold DP, Morikawa D, Muench LN, et al Negligible correlation between radiographic measurements and clinical outcomes in patients following primary reverse total shoulder arthroplasty. J Clin Med. 2021;10(4):809. doi:10.3390/jcm10040809 Cirino CM, Cagle PJ, Gobezie RB, Lederman ES, The impact of subscapularis integrity on functional outcome in reverse total shoulder arthroplasty utilizing a 135˚ stem. Semin Arthroplasty. 2021;31(4):721-729. doi:10.1053/j. sart.2021.04.010 Denard PJ, Parsons BO Cole EW, Moulton SG, Werner BC, Why patients fail to achieve a Patient Acceptable Symptom State (PASS) after total shoulder arthroplasty? JSES Int. 2021;6(1):49-55. doi:10.1016/j.jseint.2021.09.017 Denard PJ Denard PJ, Werner BC, Gobezie R, Cause for revision differs between a short and standard length stem at 5 year follow-up. Semin Arthroplasty. 2021;31(4):836-841. doi:10.1053/j.sart.2021.05.01 Cohen BS, Lederman E Erickson BJ, Chalmers PN, Denard P, et al Griffin JW, Denard P, Romeo A, Does commercially available shoulder arthroplasty preoperative planning software agree with surgeon measurements of version, inclination, and subluxation? J Shoulder Elbow Surg. 2021;30(2):413-420. doi:10.1016/j.jse.2020.05.027 Inclination correction is associated with improved clinical outcomes in anatomic total shoulder arthroplasty. Semin Arthroplasty. 2021;31(3):557-562. doi:10.1053/j.sart.2021.03.005 Gobezie R, Lederman E, Werner B Otto A, Baldino JB, Mehl J, et al Tracy ST, Werner BC, Steinbeck J, et al Werner BC, Creighton RA, Denard PJ, Lederman E, Clinical and radiological outcomes in reverse total shoulder arthroplasty by inclination angle with a modular prosthesis. Orthopedics. 2021;44(4):e527-e533. doi:10.3928/01477447-20210618-12 Revision to reverse total shoulder arthroplasty: do short stem and stemless implants reduce the operative burden compared to convertible stems? Semin Arthroplasty. 2021:31(2):248254. doi:10.1053/j.sart.2020.11.019 Prosthetic humeral head center of rotation shift from ideal is associated with inferior clinical outcomes after anatomic total shoulder arthroplasty. Semin Arthroplasty. 2021;31(4):668-676. doi:10.1053/j.sart.2021.04.004 Romeo A, Griffin JW Werner BC, Lederman E, Gobezie R, Glenoid lateralization influences active internal rotation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30(11):2498-2505. doi:10.1016/j.jse.2021.02.021 Denard PJ Werner BC, Griffin JW, Lederman E, Gobezie R, Denard PJ Glenosphere inclination and clinical outcomes after reverse shoulder arthroplasty. Semin Arthroplasty. 2021;31(3):430-437. doi:10.1053/j.sart.2020.12.014 Werner BC, Griffin JW, Thompson T, Lendhey M, Biomechanical evaluation of 2 techniques of repair after subscapularis peel for stemless shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30(10):2240-2246. doi:10.1016/j. jse.2021.01.037 Higgins LD, Denard PJ Werner BC, Lederman E, Gobezie R, Denard PJ Shah SS, Sahota S, Denard PJ, Understanding the variables that are associated with failure to achieve an acceptable symptom state after reverse shoulder arthroplasty. Semin Arthroplasty. 2021;31(4):730-736. doi:10.1053/j.sart.2021.05.001 Variability in total shoulder arthroplasty planning software compared to a control CT-derived 3D printed scapula. Shoulder Elbow. 2021;13(3):268-275. doi:10.1177/1758573219888821 et al 2020 Cole EW, Moulton SG, Gobezie R, Five-year radiographic evaluation of stress shielding with a press-fit standard length humeral stem. JSES Int. 2020;4(1):109-113. doi:10.1016/j.jses.2019.11.002 et al Denard PJ, Gobezie R, Griffin JW, Osseous integration of the central peg of an all-polyethylene glenoid with 3 different surgical techniques. Orthopedics. 2020;43(5):278-283. doi:10.3928/01477447-20200721-04 Romeo AA, Lederman E Denard PJ, Haidamous G, Gobezie R, Romeo AA, Short-term evaluation of humeral stress shielding following reverse shoulder arthroplasty using press-fit fixation compared with cemented fixation. J Shoulder Elbow Surg. 2020;29(5):906-912. doi:10.1016/j.jse.2019.09.042 Lederman E Denard PJ, Werner BC, Gobezie R, Tokish JM, Lower rates of radiolucency with a hybrid all-polyethylene pegged glenoid component compared to a completely cemented pegged glenoid component. Semin Arthroplasty. 2020;30(1):56-62. doi:10.1053/j.sart.2020.05.002 Kissenberth MJ, Ledermang E Erickson BJ, Chalmers PN, Denard PJ, Current state of short-stem implants in total shoulder arthroplasty: a systematic review of the literature. JSES Int. 2020;4(1):114-119. doi:10.1016/j.jses.2019.10.112 Gobezie R, Romeo AA, Lederman ES Erickson BJ, Shishani Y, Bishop ME, et al Subscapularis repair during reverse total shoulder arthroplasty using a stem-based double-row repair: sonographic and clinical outcomes. Orthop J Sports Med. 2020;8(3):2325967120906806. doi:10.1177/2325967120906806 Haidamous G, Lädermann A, Frankle MA, Gorman RA, The risk of postoperative scapular spine fracture following reverse shoulder arthroplasty is increased with an onlay humeral stem. J Shoulder Elbow Surg. 2020;29(12):2556-2563. doi:10.1016/j.jse.2020.03.036 Denard PJ Denard PJ, Lädermann A, Haidamous G, et al Hartzler RU, Denard PJ, Griffin JW, Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2020;29(4):E169. doi:10.1016/j.jse.2020.01.056 Surgeon acceptance of an initial 3D glenoid preoperative plan: rates and risk factors. J Shoulder Elbow Surg. 2021;30(4):787-794. doi:10.1016/j.jse.2020.06.032 Werner BC, Romeo AA Schmalzl J, Jessen M, Holschen M, et al Smith RA, Woolley K, Mazzocca A, Tuberosity healing improves functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis. Eur J Orthop Surg Traumatol. 2020;30(5):909-916. doi:10.1007/s00590-020-02649-8 Kinematics and EMG activity in reverse total shoulder arthroplasty. J Orthop. 2020;22:165169. doi:10.1016/j.jor.2020.04.017 et al 2019 Gobezie R, Shishani Y, Lederman E, Denard PJ Moulton SG, Cole EW, Gobezie R, Can a functional difference be detected in reverse arthroplasty with 135° versus 155° prosthesis for the treatment of rotator cuff arthropathy: a prospective randomized study. J Shoulder Elbow Surg. 2019;28(5):813-818. doi:10.1016/j.jse.2018.11.064 Minimum 5-year outcomes of pegged versus keeled all-polyethylene glenoids. JSES Open Access. 2019;3(4):292-295. doi:10.1016/j.jses.2019.09.006 Romeo AA, Lederman E, Denard PJ 2018 Denard PJ, Provencher MT, Lädermann A, Romeo AA, Version and inclination obtained with 3-dimensional planning in total shoulder arthroplasty: do different programs produce the same results? JSES Open Access. 2018;2(4):200-204. doi:10.1016/j.jses.2018.06.003 Parsons BO, Dines JS Denard PJ, Noyes MP, Lädermann A A tensionable method for subscapularis repair after shoulder arthroplasty. JSES Open Access. 2018;2(4):205-210. doi:10.1016/j.jses.2018.08.003 Denard PJ, Noyes MP, Walker JB, et al Denard PJ, Raiss P, Gobezie R, Edwards TB, Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty. J Shoulder Elbow Surg. 2018;27(1):53-58. doi:10.1016/j. jse.2017.06.042 Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation. J Shoulder Elbow Surg. 2018;27(6):1139-1147. doi:10.1016/j. jse.2017.12.020 Lederman E Denard PJ, Noyes MP, Walker JB, et al Romeo AA, Thorsness RJ, Sumner SA, Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty. J Shoulder Elbow Surg. 2018;27(2):217-223. doi:10.1016/j. jse.2017.08.010 Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty. J Shoulder Elbow Surg. 2018;27(1):70-74. doi:10.1016/j.jse.2017.05.026 Gobezie R, Lederman ES, Denard PJ 2017 Denard PJ, Lederman E, Parsons BO, Finite element analysis of glenoid-sided lateralization in reverse shoulder arthroplasty. J Orthop Res. 2017;35(7):1548-1555. doi:10.1002/jor.23394 Romeo AA Gobezie R, Denard PJ, Shishani Y, Romeo AA, Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty. J Shoulder Elbow Surg. 2017;26(9):1603-1608. doi:10.1016/j. jse.2017.02.013 Lederman E arthrex.com © 2024-06 Arthrex, Inc. All rights reserved. DOC1-000754-en-US_G

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BITE ISSUE 03 ANATOMIC TSA: STEM vs STEMLESS RELEASED JANUARY 2025 Mission Statement The Shoulder Arthroplasty Research Committee (ShARC) is a forward-looking global collaboration among research-focused surgeons of which the primary goal is to advance patient care. The ShARC Patient Registry is utilized to conduct patient monitoring, inform evidence-based implant design, and allow for the integration of novel technologies into clinical practice. Supported by Arthrex, the ShARC will continue to have tremendous influence on the advancement of shoulder arthroplasty through innovative research and a commitment to improve patient outcomes. ShARC Bites are developed through registry data analysis and processing of the committee’s preferences, crossreferenced with available ShARC and non-ShARC publications, to provide recommendations on current techniques and implants. Summary Recommendation ShARC recommends a stemless prosthesis for most anatomic TSAs. There does not appear to be an age cutoff, and bone quality is typically sufficient in most patients otherwise being considered appropriate for anatomic TSA. There are numerous advantages of using a stemless prosthesis over a stemmed prosthesis, as well as excellent long-term functional outcome data mirrored by early data from the US-based ShARC registry. Construct Comparison Stemless Short-Stem Mid-Length Stem Long Stem Background Although excellent clinical results have been published with both standard length and short stems, stemless anatomic total shoulder arthroplasty (TSA) offers some potential advantages. Specifically, the Eclipse™ TSA system has a unique compression-based approach providing cortical support for stemless humeral fixation compared to other impaction-based stemless prostheses. General Advantages of Stemless TSA Compared to Stemmed TSA Advantages of Eclipse™ Stemless TSA Compared to Other Stemless TSA Systems The literature supports several general advantages of stemless TSA over stemmed TSA. These include faster operative time, lower intraoperative blood loss, and easier revision. Additionally, recent ShARC studies have demonstrated improved center of rotation (COR) restoration with stemless TSA compared to stemmed TSA, as well as less early postoperative pain.2,5 The Eclipse system offers several advantages over other stemless TSA systems. The most important of these are the longest published clinical follow-up (11 years), best radiographic follow-up, and only stemless TSA with a published, validated subscapularis repair technique.2,6,7 Usage Breakdown Overall Utilization Across the US, there has been a very rapid adoption of stemless implants. Introduced to the US market in early 2020, utilization of the Eclipse system is now over 80%—and perhaps closer to 90%, as shown below. Stemless Conversion Since Launch 100% 87% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2015 Stemmed 2016 2017 Stemless 2018 2019 Eclipse Conversion % 2020 2021 2022 2023 2024 Eclipse Stemless Prosthesis Implanted Globally Since Launch 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 50,000 2017 2018 2019 2020 2021 2022 2023 2024 2025 Age Utilization of Eclipse stemless TSA in the registry continues to grow, with 307 Eclipse patients with minimum 1-year clinical outcomes and 160 patients with 2-year clinical outcomes. The mean age of Eclipse patients is 65 years (range, 31-84), and 65 years (range, 39-90) for Univers™ Apex short stem patients. A new ShARC registry study accepted for publication in JSES shows excellent outcomes of Eclipse for patients over 70 years of age with an Eclipse TSA, indicating that in the registry, age alone does not preclude surgeons from performing stemless TSA.8 Sex In the registry, 59% of Eclipse patients and 64% of Apex patients are male, and 41% of Eclipse patients and 36% of Apex patients are female. Functional Data Published data from Europe indicate excellent functional results after stemless TSA. Habermeyer’s 2021 JSES paper reported a mean constant score of 68, mean FE of 138°, and mean ER of 42° at 11 years post-op.1 The 2-year registry follow-up data on the Eclipse system are also very strong, with a mean Constant score of 80, FE of 154°, and mean ER of 63°. References 1. Magosch P, Lichtenberg S, Habermeyer P. Survival of stemless humeral head replacement in anatomic shoulder arthroplasty: a prospective study. J Shoulder Elbow Surg. 2021;30(7):e343-e355. doi:10.1016/j.jse.2020.09.034 2. Sears BW, Creighton RA, Denard PJ, et al. Stemless components lead to improved radiographic restoration of humeral head anatomy compared with short-stemmed components in total shoulder arthroplasty. J Shoulder Elbow Surg. 2023;32(2):240246. doi:10.1016/j.jse.2022.07.024 3. Werner BC, Griffin JW, Thompson T, Lendhey M, Higgins LD, Denard PJ. Biomechanical evaluation of 2 techniques of repair after subscapularis peel for stemless shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30(10):2240-2246. doi:10.1016/j.jse.2021.01.037 View the ShARC Publication List © 2025-01 Arthrex, Inc. All rights reserved. DOC1-001558-en-US_A 4. Tracy ST, Werner BC, Steinbeck J, et al. Revision to reverse total shoulder arthroplasty: do short stem and stemless implants reduce the operative burden compared to convertible stems? Semin Arthroplasty. 2021;31(4):668-676. doi:10.1053/j.sart.2021.04.004 5. Werner BC, Burrus MT, Denard PJ, et al. Stemless anatomic total shoulder arthroplasty is associated with less early postoperative pain. JSES Int. 2023;8(1):197-203. doi:10.1016/j.jseint.2023.10.012 6. Habermeyer P, Lichtenberg S, Magosch P. 9–13 Year results of stemless humeral head replacement. A prospective study. JSES Open Access. 2019;3(4):234. doi:10.1016/j.jses.2019.10.013 7. Alikhah A, Imiolczyk JP, Krukenberg A, Scheibel M. Screw fixation in stemless shoulder arthroplasty for the treatment of primary osteoarthritis leads to less osteolysis when compared to impaction fixation. BMC Musculoskelet Disord. 2020;21(1):295. doi:10.1186/s12891-020-03277-3 8. Dillon MT, Denard P, ShARC, Werner B. Results of anatomic total shoulder arthroplasty with the Arthrex Eclipse™ stemless humeral implant in patients over 70. J Shoulder Elbow Surg.Accepted for publication.

ShARC BITE - Anatomic TSA: Stem vs Stemless

BITE ISSUE 01 SCREW vs POST in REVERSE TSA RELEASED JANUARY 2025 Mission Statement The Shoulder Arthroplasty Research Committee (ShARC) is a forward-looking global collaboration among research-focused surgeons of which the primary goal is to advance patient care. The ShARC Patient Registry is utilized to conduct patient monitoring, inform evidence-based implant design, and allow for the integration of novel technologies into clinical practice. Supported by Arthrex, the ShARC will continue to have tremendous influence on the advancement of shoulder arthroplasty through innovative research and a commitment to improve patient outcomes. ShARC Bites are developed through registry data analysis and processing of the committee’s preferences, crossreferenced with available ShARC and non-ShARC publications, to provide recommendations on current techniques and implants. Summary Recommendation The ShARC does not have a consensus for the use of a central screw or post fixation with nonaugmented baseplates in reverse total shoulder arthroplasty. Both can provide stable fixation with excellent clinical outcomes and can therefore be chosen based on surgeon preference. To maximize baseplate stability, regardless of central fixation method used, the ShARC recommends increasing length with bicortical placement when possible in addition to using 3 to 4 peripheral screws. Construct Comparison Central Screws Central Posts Background Biomechanical analysis has shown that both central screw and post configurations provide adequate fixation with no significant difference in micromotion.1 Similarly, clinical and radiographic outcomes at short-term follow-up are equivalent.2 Regardless of the central fixation method used, important considerations when performing reverse total shoulder arthroplasty (RTSA) include the length of central fixation, length of peripheral fixation, and type of peripheral fixation, which have all been shown to affect baseplate stability.1-7 We conducted a ShARC surgeon survey to identify their fixation preferences and below are the results.8 Central Screw vs Post Usage When no significant glenoid deformity is present, 54% of ShARC surgeons prefer a central post, while 46% prefer a central screw. Lateralizing the center of rotation does not affect the majority of surgeons’ preference for central fixation. Does Lateralizing +2 mm Change Central Fixation Preference? Does Lateralizing +4 mm Change Central Fixation Preference? 100% 100% 96% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 90% 10% 10% 4% 0% 0% Yes No Yes No Central Fixation Length Whether using a post or screw, the majority of ShARC surgeons aim for bicortical fixation. With central screw fixation, 96% of surgeons always or usually go bicortical. When using a central post, 75% of surgeons always or usually go bicortical. Bicortical Central Screw Placement Bicortical Central Post Placement 100% 100% 90% 90% 80% 80% 70% 70% 64% 60% 60% 50% 50% 40% 40% 32% 30% 46% 30% 20% 29% 25% 20% 10% 0% 0% Always Usually Rarely 4% 10% 0% 0% Never Always Usually Rarely Never Bicortical fixation preference increases to greater than 90% with increasing lateralization off the baseplate. This is consistent with literature suggesting that longer central screw or post length and bicortical fixation increases baseplate stability.1,3,4 Peripheral Screw Usage Regardless of central fixation method used, ShARC surgeons routinely use either a combination of compression and locking screws or all locking screws for peripheral fixation. Whether using a central screw or post, the majority prefer to use all locking screws. The use of at least one peripheral locking screw is preferred. Using a combination of compression and locking screws provides stable baseplate fixation; however, increasing the number of locking screws decreases micromotion and increases consistency.5 All ShARC surgeons routinely use a minimum of 2 peripheral screws for added stability. The majority routinely prefer 4 peripheral screws when sufficient bone stock allows, but more often use 3 screws 50%-68% of the time depending on the central fixation. Stable fixation has been reported with the use of 2 screws, but most studies have reported on medialized designs.6,7 Peripheral Screw Usage Number of Peripheral Screws 100% 100% 90% 90% 80% 80% 75% 60% 60% 60% 50% 50% 50% 40% 40% 40% 30% 30% 21% 20% 10% 0% 68% 70% 70% 0% 21% 20% 10% 4% 29% 21% 11% 0% All Compression Central Screw All Locking Combination Central Post 2 screws 3 screws Central Screw Central Post 4 screws References 1. Bonnevialle N, Geais L, Müller JH; Shoulder Friends Institute, Berhouet J. Effect of RSA glenoid baseplate central fixation on micromotion and bone stress. JSES Int. 2020;4(4):979-986. doi:10.1016/j.jseint.2020.07.004 2. Bercik MJ, Werner BC, Sears BW, Gobezie R, Lederman E, Denard PJ. A comparison of central screw versus post for glenoid baseplate fixation in reverse shoulder arthroplasty using a lateralized glenoid design. J Clin Med. 2022;11(13):3763. doi:10.3390/jcm11133763 3. Lung TS, Cruickshank D, Grant HJ, Rainbow MJ, Bryant TJ, Bicknell RT. Factors contributing to glenoid baseplate micromotion in reverse shoulder arthroplasty: a biomechanical study. J Shoulder Elbow Surg. 2019;28(4):648-653. doi:10.1016/j. jse.2018.09.012 4. Königshausen M, Jettkant B, Sverdlova N, et al. Influence of different peg length in glenoid bone loss: a biomechanical analysis regarding primary stability of the glenoid baseplate in reverse shoulder arthroplasty. Technol Health Care. 2015;23(6):855-869. doi:10.3233/THC-151031 5. Formaini NT, Everding NG, Levy JC, Santoni BG, Nayak AN, Wilson C. Glenoid baseplate fixation using hybrid configurations of locked and unlocked peripheral screws. J Orthop Traumatol. 2017;18(3):221-228. doi:10.1007/s10195-016-0438-3 6. James J, Allison MA, Werner FW, et al. Reverse shoulder arthroplasty glenoid fixation: is there a benefit in using four instead of two screws? J Shoulder Elbow Surg. 2013;22(8):1030-1036. doi:10.1016/j.jse.2012.11.006 7. Roche C, DiGeorgio C, Yegres J, et al. Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates. JSES Open Access. 2019;3(4):296-303. doi:10.1016/j. jses.2019.08.006 8. Arthrex, Inc. ShARC Consensus Statement Survey. Naples, FL; October 2023. View the ShARC Publication List © 2025-01 Arthrex, Inc. All rights reserved. DOC1-001274-en-US_D

ShARC BITE - Screw vs Post in Reverse TSA

BITE ISSUE 06 BASEPLATE BACKSIDE CONTACT IN REVERSE TSA RELEASED JANUARY 2025 Mission Statement The Shoulder Arthroplasty Research Committee (ShARC) is a forward-looking global collaboration among research-focused surgeons of which the primary goal is to advance patient care. The ShARC Patient Registry is utilized to conduct patient monitoring, inform evidence-based implant design, and allow for the integration of novel technologies into clinical practice. Supported by Arthrex, the ShARC will continue to have tremendous influence on the advancement of shoulder arthroplasty through innovative research and a commitment to improve patient outcomes. ShARC Bites are developed through registry data analysis and processing of the committee’s preferences, crossreferenced with available ShARC and non-ShARC publications, to provide recommendations on current techniques and implants. Summary Recommendation Overall, the ShARC group recommends at least 75% backside contact for the baseplate in reverse total shoulder arthroplasty regardless of central screw or central post fixation. With decreased backside contact, the number of peripheral screws used should increase to improve stability. If 4 mm or more of glenoid bone reaming is needed to achieve backside seating, ShARC surgeons prefer to use an augment to maximize backside contact while preserving glenoid bone stock. Background The Modular Glenoid System offers a large portfolio of baseplate options to accommodate various types of glenoid deformities. There are two diameters offered for standard baseplates in addition to 10˚ or 20˚ full-wedge augmented baseplates and 15˚, 25˚, or 35˚ half-wedge augmented baseplates, all with options for lateralization. These options allow for optimal backside contact and glenoid bone preservation. The system also has the option for central screw or central post fixation for nonaugmented baseplates and a central post fixation for augmented baseplates. Data Biomechanical studies have shown that baseplate contact less than 50% compromises the stability of the baseplate as it exceeds the 150-μm micromotion threshold for bone ingrowth.1,2 Metal augmentation can be used in place of bone graft for glenoid reconstruction with good and comparable short-term outcomes.3,4 Peripheral screw orientation in the baseplate has not been shown to make a difference in baseplate stability, but longer screws and potentially a higher number of screws have been shown to have stronger initial baseplate fixation.5,6 ShARC Survey Data Most ShARC members prefer to achieve greater than 75% backside contact regardless of using central post or central screw fixation. Percentage of Backside Contact With Central Post Percentage of Backside Contact With Central Screw 100% 100% 90% 80% 90% 82% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 8% 0% 0% >75% 51% - 75% 25% - 75% 60% 18% 22% 10% 0% 0% >75% Other 51% - 75% 25% - 75% Other If the backside contact is between 50%-75% with a nonaugmented baseplate, the majority (85%) of ShARC surgeons will use an augmented baseplate to achieve better contact before reverting to a custom-made baseplate. If 2 to 4 mm of bone needs to be reamed to achieve the desired backside contact, 36% of ShARC surgeons are changing to an augmented component to preserve glenoid bone stock. If the amount of bone to be reamed is greater than 4 mm, an additional 54% of ShARC surgeons are using an augmented component. This equates to 90% of ShARC surgeons using an augment if more than 4 mm of reaming is needed on the glenoid. Backside Contact Percentage for Conversion to Augmented Baseplate Ream Depth for Conversion to Augmented Baseplate 100% 100% 90% 80% 80% 70% 70% 60% 60% 50% 40% 90% 90% 85% 39% 46% 54% 50% 40% 30% 36% 30% 20% 20% 10% 7% 8% 25% Other 0% 10% 7% 5% <2 mm Other 0% 75% 50% >4 mm 2 mm - 4 mm When using an augmented baseplate, nearly all (96%) ShARC surgeons want over 75% backside contact. Desired Backside Contact Percentage When Using an Augment 100% 90% 96% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0% 51% - 75% 25% - 75% 0% >75% 4% Other For ShARC surgeons, the number of peripheral screws used increases if there is less than 75% backside contact. Peripheral Screw Usage When Good Backside Contact Peripheral Screw Usage When <75% Backside Contact 100% 100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 40% 50% 42% 29% 30% 40% 29% 30% 20% 20% 10% 10% 0% 0% 4 71% 3 2 Other 14% 10% 5% 0% 4 3 2 Other References 1. Martin EJ, Duquin TR, Ehrensberger MT. Reverse total shoulder glenoid baseplate stability with superior glenoid bone loss. J Shoulder Elbow Surg. 2017;26(10):17481755. doi:10.1016/j.jse.2017.04.020 2. Formaini NT, Everding NG, Levy JC, et al. The effect of glenoid bone loss on reverse shoulder arthroplasty baseplate fixation. J Shoulder Elbow Surg. 2015;24(11):e312-e319. doi:10.1016/j.jse.2015.05.045 3. Jasty M, Bragdon C, Burke D, O’Connor D, Lowenstein J, Harris WH. In vivo skeletal responses to porous-surfaced implants subjected to small induced motions. J Bone Joint Surg Am. 1997;79(5):707-714. doi:10.2106/00004623-199705000-00010 4. Van de Kleut ML, Yuan X, Teeter MG, Athwal GS. Bony increased-offset reverse shoulder arthroplasty vs. metal augments in reverse shoulder arthroplasty vs metal augments in reverse shoulder arthroplasty: a prospective, randomized clinical trial with 2-year follow up. J Shoulder Elbow Surg. 2022;31(3):591-600. doi:10.1016/j.jse.2021.11.007 View the ShARC Publication List © 2025-01 Arthrex, Inc. All rights reserved. DOC1-001604-en-US_B 5. Abdic S, Lockhart J, Alnusif N, Johnson JA, Athwal GS. Glenoid baseplate screw fixation in reverse shoulder arthroplasty: does locking screw position and orientation matter?. J Shoulder Elbow Surg. 2021;30(5):1207-1213. doi:10.1016/j. jse.2020.08.009 6. Roche C, DiGeorgio C, Yegres J, et al. Impact of screw length and screw quantity on reverse total shoulder arthroplasty glenoid fixation for 2 different sizes of glenoid baseplates. JSES Open Access. 2019;3(4):296-303. doi:10.1016/j. jses.2019.08.006

ShARC BITE - Baseplate Backside Contact in Reverse TSA

BITE ISSUE 02 GLENOID LATERALIZATION IN REVERSE TSA RELEASED JANUARY 2025 Mission Statement The Shoulder Arthroplasty Research Committee (ShARC) is a forward-looking global collaboration among research-focused surgeons of which the primary goal is to advance patient care. The ShARC Patient Registry is utilized to conduct patient monitoring, inform evidence-based implant design, and allow for the integration of novel technologies into clinical practice. Supported by Arthrex, the ShARC will continue to have tremendous influence on the advancement of shoulder arthroplasty through innovative research and a commitment to improve patient outcomes. ShARC Bites are developed through registry data analysis and processing of the committee’s preferences, crossreferenced with available ShARC and non-ShARC publications, to provide recommendations on current techniques and implants. Summary Recommendation In most cases, the ShARC group recommends 6 to 8 mm of lateralization with a nonaugmented baseplate and 4 to 6 mm of lateralization with an augmented baseplate to maximize range of motion, particularly internal rotation. Most ShARC surgeons decrease lateralization for women (4 to 6 mm as opposed to 6 to 8 mm in men) and in a fracture setting (2 to 4 mm reduction). Construct Comparison Standard Constructs Lateralized Constructs Background The Modular Glenoid System (MGS) provides the ability to lateralize from 0 to 8 mm in 2 mm increments with nonaugmented baseplates. With augmented baseplates, 0 to 6 mm of lateralization can be achieved. The potential benefits of glenoid-side lateralization are decreased bony impingement and improved stability through soft-tissue tensioning. Furthermore, decreased scapular notching improves range of motion, most importantly with respect to internal rotation.1-3 Theoretical risks with lateralization have included baseplate failure and increased risk of stress fracture. Clinical outcomes of the MGS have demonstrated a less than 2% failure rate despite being implanted with up to 6 or 8 mm of lateralization.4 Additionally, it has been demonstrated that lateralization is not associated with stress fracture, but rather that distalization increases the risk of stress fracture.5 Usage Breakdown The majority of ShARC surgeons favor glenoid-sided lateralization. Among nonaugmented baseplates within the registry, 81% of cases were implanted with 6 to 8 mm of lateralization. Among augmented baseplates within the registry, 86% of cases were implanted with 4 to 6 mm of lateralization. Nonaugmented Baseplate Lateralization Augmented Baseplate Lateralization 100% 100% 90% 90% 81% 80% 80% 70% 70% 60% 60% 50% 35% 30% 0% 40% 36% 30% 20% 10% 50% 50% 47% 40% 86% 20% 14% 12% 10% 2% 3% 0 mm 2 mm 0% 4 mm 6 mm 8 mm 1% 0 mm 2 mm 4 mm 6 mm Functional Data Published data from the ShARC registry indicate that increasing glenoid lateralization improves internal rotation (IR). In a series of 455 patients Werner et al demonstrated that 6 to 8 mm of lateralization improves IR compared to 2 mm or less of lateralization with standard baseplates.6 Variance in Lateralization: A ShARC Surgeon Preference Survey ShARC surgeons vary lateralization by sex due to size differences. For male patients, 6 to 8 mm is favored by more than 90% of surgeons. In female patients, 4 to 6 mm of lateralization is favored by 87% of surgeons. Sixty-five percent of ShARC surgeons also decrease lateralization by 2 to 4 mm in a fracture setting. Preferred Lateralization in Men Preferred Lateralization in Women 100% 100% 91% 90% 80% 80% 70% 70% 60% 60% 52% 50% 48% 50% 39% 40% 30% 20% 20% 4% 10% 4% 0% 39% 40% 30% 10% 87% 90% 4% 4% 0% 2 mm 4 mm 6 mm 8 mm 2 mm 4 mm 6 mm 8 mm References 1. Walch G. What I’ve learned? J Shoulder Elbow Surg. 2019;28(6):1214-1216. doi:10.1016/j.jse.2019.02.018 2. Gobezie R, Shishani Y, Lederman E, Denard PJ. Can a functional difference be detected in reverse arthroplasty with 135° versus 155° prosthesis for the treatment of rotator cuff arthropathy: a prospective randomized study. J Shoulder Elbow Surg. 2019;28(5):813-818. doi:10.1016/j.jse.2018.11.064 3. Haidamous G, Lädermann A, Frankle MA, Gorman RA 2nd, Denard PJ. The risk of postoperative scapular spine fracture following reverse shoulder arthroplasty is increased with an onlay humeral stem. J Shoulder Elbow Surg. 2020;29(12):2556-2563. doi:10.1016/j.jse.2020.03.036 4. Bercik MJ, Werner BC, Sears BW, Gobezie R, Lederman E, Denard PJ. A comparison of central screw versus post for glenoid baseplate fixation in reverse shoulder arthroplasty using a lateralized glenoid design. J Clin Med. 2022;11(13):3763. doi:10.3390/jcm11133763 5. Pak T, Ardebol J, Menendez ME, et al. Robert H. Cofield, MD, Award for Best Oral Presentation 2023: Up to 8 mm of glenoid-sided lateralization does not increase the risk of acromial or scapular spine stress fracture following reverse shoulder arthroplasty with a 135° inlay humeral component. J Shoulder Elbow Surg. 2024;33(6S):S1-S8. doi:10.1016/j.jse.2023.11.018 6. Werner BC, Lederman E, Gobezie R, Denard PJ. Glenoid lateralization influences active internal rotation after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30:2498-2505. doi:10.1016/j.jse.2021.02.021 View the ShARC Publication List © 2025-01 Arthrex, Inc. All rights reserved. DOC1-001559-en-US_C

ShARC BITE - Glenoid Lateralization in Reverse TSA

BITE ISSUE 07 GLENOID INCLINATION IN ANATOMIC TSA RELEASED JANUARY 2025 Mission Statement The Shoulder Arthroplasty Research Committee (ShARC) is a forward-looking global collaboration among research-focused surgeons of which the primary goal is to advance patient care. The ShARC Patient Registry is utilized to conduct patient monitoring, inform evidence-based implant design, and allow for the integration of novel technologies into clinical practice. Supported by Arthrex, the ShARC will continue to have tremendous influence on the advancement of shoulder arthroplasty through innovative research and a commitment to improve patient outcomes. ShARC Bites are developed through registry data analysis and processing of the committee’s preferences, crossreferenced with available ShARC and non-ShARC publications, to provide recommendations on current techniques and implants. Summary Recommendation Absent deformity, most ShARC surgeons aim to match native glenoid inclination. If correcting, the majority aim for less than 5˚ of inferior inclination, with the goals of improving and protecting supraspinatus function and preventing proximal humeral migration. However, inferior inclination should not be achieved by excessive reaming and compromise of subchondral bone support, with nearly all surgeons stating they would not ream more than 3 mm to correct glenoid inclination. Background The ideal inclination for the glenoid component in anatomic shoulder arthroplasty for glenohumeral osteoarthritis has not been well defined. Finite element, cadaveric, and clinical outcome and radiographic studies have provided some insights, but the data is insufficient to establish a standardized position for all patients. When preoperative inclination exceeds 10° but is properly corrected, it does not seem to have a major impact on the postoperative results of anatomic TSA. However, there is a notable link between postoperative inclination and Constant scores at the 2-year mark, with correction of inclination correlating to improved postoperative Constant scores.1 These findings highlight the importance of further research to better understand and optimize inclination correction for achieving positive and lasting outcomes after anatomic TSA. Jacxsens et al found that preoperative glenoid inclination was the sole anatomical factor affecting clinical outcomes, with increased inferior inclination associated with significantly reduced Constant scores at final follow-up.2 Terrier et al used a numeric musculoskeletal model to assess the benefit of inferior inclination of the glenoid component to balance supraspinatus insufficiency, finding that it improved balance and reduced proximal humeral migration but required additional subchondral bone reaming, reducing bone support and increasing cement deformation and stress.3 Knighton et al used a cadaveric shoulder simulator to study joint contact and muscle forces with isolated changes in glenoid inclination, finding that inferior glenoid inclination reduced both compressive and superior-inferior shear forces compared to neutral inclination by up to 40%, potentially reducing the likelihood of glenoid loosening. However, the impact of corrective reaming and loss of subchondral bone to achieve that inclination was not defined.4 Hopkins et al performed a finite element analysis of five different glenoid component alignments to evaluate the survivability of the cement mantle surrounding the glenoid component, finding that the quality of the supporting bone stock was particularly significant to cement survivability, with a superiorly inclined glenoid component performing worst overall.5 Gregory et al reported that an inferiorly inclined glenoid component was associated with an increased incidence of radiolucent lines and osteolysis after total shoulder arthroplasty.6 Results Twenty-eight high-volume shoulder arthroplasty surgeons were surveyed regarding their goal and preference for glenoid component position in anatomic shoulder arthroplasty. Only 21% of surgeons stated they did not have a target goal for inclination, while 50% said they aim for less than 10˚ of glenoid inclination. Twenty percent of surgeons indicated improved function of the rotator cuff as the primary reason for this preference, while others cited reduced shear forces and cement mantle stresses. Ninety-six percent of surgeons reported 3 mm to be the upper limit of reaming that is acceptable to achieve this desired correction, given concerns about loss of subchondral bone support for the implant. Do you have an absolute goal for glenoid inclination in anatomic TSA? What is your upper limit of acceptable inferior glenoid reaming in anatomic TSA? 100% 100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 20% 86% 50% 40% 30% 96% 40% 30% 21% 14% 14% 10% 20% 10% 4% 10% 0% 0% No Yes, <10˚ Yes, <5˚ Yes, 0˚ <1 mm of Inferior Glenoid Reaming 1-3 mm of Inferior Glenoid Reaming 3-5 mm of Inferior Glenoid Reaming Absent deformity, 61% of surgeons aim to match the native anatomy of the glenoid, while 32% aim to introduce 2° to 5° of inferior tilt to improve rotator cuff function and prevent proximal humeral migration. Do you have an absolute goal for inferior tilt in anatomic TSA? 100% 90% 80% 70% 60% 61% 50% 40% 32% 30% 25% 20% 10% 7% 7% 3˚-5˚ of Inferior Tilt >5˚ of Inferior Tilt 0% Match the Anatomy 2˚-3˚ of Inferior Tilt References 1. Griffin JW, Denard P, Romeo A, Gobezie R, Lederman E, Werner B. Inclination correction is associated with improved clinical outcomes in anatomic total shoulder arthroplasty. Semin Arthroplasty. 2021;31:557-562. https://doi.org/10.1053/j.sart.2021.03.005 2. Jacxsens M, Henninger H, Van Tongel A, De Wilde L. Serial 3D CT analysis of humeral head alignment in relation to glenoid correction and outcomes after total shoulder arthroplasty. JSES International. 2023; 7:485-492. 3. Terrier A, Merlini F, Pioletti DP, Farron A. Total shoulder arthroplasty: Downward inclination of the glenoid component to balance supraspinatus deficiency. Journal Shoulder Elbow Surgery. 2009; 18:360-365. 4. Knighton TW, Chalmers PN, Sulkar HJ, Aliaj K, Tashjian RZ, Henninger HB. Anatomic total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study. Journal Shoulder Elbow Surgery. 2022; 31:2023-2033. 5. Hopkins AR, Hansen UN, Amis AA, Emery R. The effects of glenoid component alignment variations on cement mantle stresses in total shoulder arthroplasty. Journal Shoulder Elbow Surgery. 2004; 13:668-675. 6. Gregory TM, Sankey A, Augereau B, Vandenbussche E, Amis A, Emery R, Hansen U. Accuracy of Glenoid Component Placement in Total Shoulder Arthroplasty and Its Effect on Clinical and Radiological Outcome in a Retrospective, Longitudinal, Monocentric Open Study. PLOS One. 2013; 8:75791-75796. View the ShARC Publication List © 2025-03 Arthrex, Inc. All rights reserved. DOC1-001603-en-US_B

ShARC BITE - Glenoid Inclination In Anatomic TSA

BITE ISSUE 05 GLENOSPHERE OVERHANG IN REVERSE TSA RELEASED JANUARY 2025 Mission Statement The Shoulder Arthroplasty Research Committee (ShARC) is a forward-looking global collaboration among research-focused surgeons of which the primary goal is to advance patient care. The ShARC Patient Registry is utilized to conduct patient monitoring, inform evidence-based implant design, and allow for the integration of novel technologies into clinical practice. Supported by Arthrex, the ShARC will continue to have tremendous influence on the advancement of shoulder arthroplasty through innovative research and a commitment to improve patient outcomes. ShARC Bites are developed through registry data analysis and processing of the committee’s preferences, crossreferenced with available ShARC and non-ShARC publications, to provide recommendations on current techniques and implants. Summary Recommendation In reverse total shoulder arthroplasty, 93% of ShARC members prefer 0 to 2 mm of inferior glenosphere overhang. Previous work has shown that inferior overhang seems to improve outcomes but also increases the risk of stress fracture. As such, we may want to strive for inferiorly flush positioning, erring on the side of minimal inferior overhang if needed. Additionally, 78% of ShARC members preferred the glenosphere to be either flush or have 1 mm of over-coverage with the glenoid in the A-P direction. This practice is supported by recent evidence from the ShARC demonstrating that an increased subcoracoid distance, which is directly affected by glenosphere sizing, is ideal to optimize internal rotation and reduce anterior shoulder pain after RTSA.1 Construct Comparison Glenosphere Overhang Inferiorly Flush Glenosphere Background The ideal glenoid to glenosphere positioning in reverse total shoulder arthroplasty (RTSA) remains elusive. While most surgeons agree that inferior baseplate placement on the glenoid is preferred, it is unclear where the proper positioning of the glenosphere should be to maximize range of motion (ROM) and minimize complications.2 An earlier study using different implants has found that a greater amount of inferior overhang (>9.9 mm vs <7.1 mm) correlated to a significantly greater amount of active forward elevation.3 Another study showed that a greater amount of inferior overhang (3.1 mm vs 1.4 mm) demonstrated improvement in ROM and clinical outcome scores.4 In the previous study, for every 1 mm increase in inferior glenosphere overhang, there was a 1.5× increase in the chance of achieving an excellent outcome. However, these findings should be considered alongside those of Pak et al, who found that increased inferior overhang increases the risk of stress fracture.5 Data When the ShARC members were surveyed on the ideal amount of inferior glenosphere overhang in RTSA, there was no consensus among the group. Overall, 93% preferred the glenosphere to have 2 mm of overhang or less; 21% preferred the glenosphere to be flush; 43% preferred 1 mm of inferior overhang; and 29% preferred 2 mm of inferior overhang. Only 7% wanted more than 2 mm of inferior overhang. When surveyed on the anterior to posterior (A-P) coverage of the glenosphere, most ShARC members preferred the glenosphere to be flush with the glenoid A-P (46%) or have 1 mm of A-P over-coverage (32%). Fewer preferred 2 mm of A-P over-coverage (18%) and only 4% wanted slight under-coverage. Ideal Inferior Glenosphere Overhang 100% 93% 90% Percentage of ShARCs 80% 70% 60% 50% 43% 40% 29% 30% 20% 21% 7% 10% 0% Flush With Inferior Glenoid 1 mm Inferior Overhang 2 mm Inferior Overhang >2 mm Inferior Overhang Ideal Anterior/Posterior Glenosphere Overhang 100% 90% 78% Percentage of ShARCs 80% 70% 60% 50% 46% 40% 32% 30% 18% 20% 10% 4% 0% Flush Anterior to Posterior 1 mm Anterior and Posterior Over-Coverage 2 mm Anterior and Posterior Over-Coverage Slight Under-Coverage References 1. Klosterman EL, Tagliero AJ, Lenters TR, et al. The subcoracoid distance is correlated with pain and internal rotation after reverse shoulder arthroplasty. JSES Int. 2024;8(3):528-534. doi:10.1016/j.jseint.2024.01.010 2. Collotte P, Bercik M, Vieira TD, Walch G. Long-term reverse total shoulder arthroplasty outcomes: the effect of the inferior shifting of glenoid component fixation. Clin Orthop Surg. 2021;13(4):505-512. doi:10.4055/cios20245 3. Dean EW, Dean NE, Wright TW, Hao KA, Schoch BS, Farmer KW, et al. Clinical outcomes related to glenosphere overhang in reverse shoulder arthroplasty using a lateralized humeral design. J Shoulder Elbow Surg. 2022;31(10):2106-2115. doi:10.1016/j.jse.2022.03.014 4. Haidamous G, Ladermann A, Hartzler RU, Parsons BO, Lederman ES, Tokish JM, et al. Radiographic parameters associated with excellent versus poor range of motion outcomes following reverse shoulder arthroplasty. Shoulder Elbow. 2022;14(1):39-47. doi:10.1177/1758573220936234 5. Pak T, Ardebol J, Menendez ME, et al. Robert H. Cofield, MD, Award for Best Oral Presentation 2023: Up to 8 mm of glenoid-sided lateralization does not increase the risk of acromial or scapular spine stress fracture following reverse shoulder arthroplasty with a 135° inlay humeral component. J Shoulder Elbow Surg. 2024;33(6S):S1-S8. doi:10.1016/j.jse.2023.11.018 View the ShARC Publication List © 2025-01 Arthrex, Inc. All rights reserved. DOC1-001576-en-US_A

ShARC BITE - Glenosphere Overhang in Reverse TSA

BITE ISSUE 04 CORRECTIVE REAMING IN ANATOMIC TSA RELEASED JANUARY 2025 Mission Statement The Shoulder Arthroplasty Research Committee (ShARC) is a forward-looking global collaboration among research-focused surgeons of which the primary goal is to advance patient care. The ShARC Patient Registry is utilized to conduct patient monitoring, inform evidence-based implant design, and allow for the integration of novel technologies into clinical practice. Supported by Arthrex, the ShARC will continue to have tremendous influence on the advancement of shoulder arthroplasty through innovative research and a commitment to improve patient outcomes. ShARC Bites are developed through registry data analysis and processing of the committee’s preferences, crossreferenced with available ShARC and non-ShARC publications, to provide recommendations on current techniques and implants. Summary Recommendation In anatomic total shoulder arthroplasty, the majority of ShARC surgeons will use a standard glenoid component and perform corrective reaming of a B2 glenoid in cases with preoperative retroversion of 15˚ or less and an augmented glenoid component in cases with 15° to 25° of retroversion. Further, the vast majority of ShARC surgeons limit their corrective reaming to <3 mm in an effort to preserve subchondral bone. Finally, the majority of ShARC surgeons feel that the upper limit for utilizing an augmented anatomic glenoid component is 25˚ of glenoid retroversion. Construct Comparison Glenoid Reamer Background Management of glenoid deformity in anatomic total shoulder arthroplasty is accomplished through a variety of options based on severity of deformity, patient age and activity level, as well as surgeon preference and experience. The Walch classification delineates the common glenoid pathologic deformities and recognizes that the B2 or “biconcave” glenoid is a common deformity observed in primary glenohumeral arthritis.1 Historically, especially prior to the availability of augmented polyethylene anatomic glenoid components, the B2 glenoid was managed with corrective or “high-side” reaming in an effort to correct pathologic glenoid retroversion to a more anatomic version and improve backside seating of the glenoid component. Classic limitations to corrective reaming have been delineated by Iannotti and others and include reaming <3-4 mm to preserve glenoid subchondral bone and correcting <15˚ of deformity.2 Recently, a series published by Harold et al found that at a mean of 8 years follow-up, 88% of glenoid components in 34 shoulders remained well fixed radiographically following corrective reaming of glenoids, with an average preoperative retroversion of 19˚.3 Corrective Reaming ShARC Surgeon Preference Survey Results When managing a B2 glenoid in anatomic total shoulder arthroplasty, 96% of ShARC surgeons will perform a corrective reaming technique for preoperative glenoid retroversion of 10˚ and 75% will perform corrective reaming in cases with up to 15˚ of glenoid retroversion. When assessing depth of corrective reaming, 85% of ShARC surgeons limit the depth to <3 mm and 100% limit it at <5 mm. Corrective Reaming of B2 Glenoid in Anatomic Total Shoulder Arthroplasty 100% 90% 100% 96% 80% 85% 70% 75% 60% 50% 40% 30% 20% 10% 0% Retroversion of 10˚ Retroversion of <15˚ <3 mm Depth of Reaming <5 mm Depth of Reaming In cases where glenoid retroversion increases to 20˚, 96% of ShARC surgeons prefer to use an augmented polyethylene anatomic glenoid component. However, if glenoid retroversion is >25˚, 93% of ShARC surgeons state that the severity of retroversion is too much to be optimally managed with an augmented polyethylene glenoid component and would consider performing a reverse total shoulder arthroplasty. References 1. Walch G, Badet R, Boulahia A, Khoury A. Morphologic study of the glenoid in primary glenohumeral arthritis. J Arthroplasty. 1999;14:756-760. doi:10.1016/ s0883-5403(99)90232-2 2. Ho JC, Savesan VJ, Iannotti JP. Glenoid component retroversion is associated with osteolysis. J Bone Joint Surg Am. 2013;95:e82. doi:10.2106/JBJS.L.00336 3. Harold RE, Sweeney PT, Torchia MT, Chamberlain AM, Keener JD. Total shoulder arthroplasty in patients with a B2 glenoid addressed with corrective reaming: mean of 8-year follow up. J Shoulder Elbow Surg. 2023;32:S8-S16. doi:10.1016/j.jse.2022.12.019 View the ShARC Publication List © 2025-01 Arthrex, Inc. All rights reserved. DOC1-001577-en-US_A

ShARC BITE - Corrective Reaming in Anatomic TSA

The combined use of CeMend™ molds and spacers allows for complete customization to create a mono block spacer for complex revision cases.

AAOS 2025 Annual Meeting: Shoulder Arthroplasty and Fracture Feature Products