Total reverse shoulder systems and methods

Abstract

To provide novel reverse shoulder systems.SOLUTION: A reverse shoulder system can include, for example, a glenoid baseplate comprising a longitudinal axis, the glenoid baseplate further including a stem and a central channel within a sidewall of the stem. The stem can include a longitudinal axis. The longitudinal axis of the glenoid baseplate can be angled with respect to the longitudinal axis of the stem, where the longitudinal axis of the glenoid baseplate is not perpendicular to the longitudinal axis of the stem. Other components including a glenosphere, tools, and methods of use are also disclosed.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] This application claims the benefit as a patent application under 35 U.S.C. §119(e) of U.S. Provisional Patent Application No. 62 / 816,708, which is incorporated herein by reference in its entirety. [Background technology]

[0002] Shoulder replacement is a commonly performed medical procedure for the treatment of osteoarthritis, rheumatoid arthritis, and some deformities associated with oncological conditions and trauma. There are two main types of shoulder replacement available to surgeons: anatomical and reverse. In the anatomical type, surgeons replace the articular surface with engineered materials so that it has a shape substantially identical to the natural anatomy. A stem can typically be fixed within the canal of the humerus, and a metallic condyle can be rigidly fixed to its proximal surface, which has a convex articular surface adapted to articulate with a glenoid implant. The glenoid implant can include several pegs, posts, or fins on its posterior (medial) side that are adapted to be rigidly fixed within the glenoid cavity of the scapula, and a concave or flat articular surface on its anterior side that is adapted to articulate with the humeral head of a humeral implant.

[0003] When a reverse prosthesis is used, the articular surfaces are inverted in that the metal ball is rigidly fixed in the glenoid cavity of the scapula and the concave articular surface is rigidly fixed to the humerus, thereby reversing the articulation pattern of the prosthesis.

[0004] Surgeons choose between the two types of prosthesis by assessing a number of factors, including the patient's pain level, activity level, deformity or severity of bone deterioration, strength of the surrounding soft tissues, and whether or not they have had previous surgery, particularly the health and strength of the rotator cuff muscles and tendons. Rotator cuff disease is common among patients with shoulder arthritis. In this situation, it has been commonly observed that the absence of rotator cuff dysfunction leads to an anatomical shoulder replacement prosthesis being insufficiently stabilized by the surrounding soft tissues. In this case, a reverse shoulder replacement prosthesis may be preferred in some cases due to the inherent stability of the joint. Additionally, by adjusting the position of the articular surfaces within the joint, a reverse prosthesis can advantageously utilize remaining muscles in a manner that may be more effective in the absence of other soft tissue structures. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] U.S. Patent No. 8,007,538 [Patent Document 2] U.S. Patent No. 8,778,028 [Patent Document 3] U.S. Patent Application Publication No. 2018 / 0368982 Summary of the Invention [Means for solving the problem]

[0006] In some embodiments, disclosed herein is a reverse shoulder system including any number of glenoid baseplates including a longitudinal axis, the glenoid baseplate further including a stem and a central channel in a sidewall of the stem, the stem including a longitudinal axis. The longitudinal axis of the glenoid baseplate can be angled relative to the longitudinal axis of the stem, where the longitudinal axis of the glenoid baseplate is not perpendicular to the longitudinal axis of the stem.

[0007] In some configurations, the glenoid baseplate includes a generally disc-shaped portion extending radially outward from the central channel.

[0008] In some configurations, the stem includes a sidewall that extends upwardly relative to the disc portion.

[0009] In some configurations, the glenoid baseplate includes a periphery.

[0010] In some configurations, the periphery includes spaced anti-rotation features.

[0011] In some configurations, the anti-rotation feature includes a slot.

[0012] In some configurations, the lower portion of the periphery includes a porous coating.

[0013] In some configurations, the lower surface of the generally disc-shaped portion includes a porous coating, while the upper surface does not.

[0014] In some configurations, the periphery and / or the lower surface of the base plate includes a conical shape.

[0015] In some configurations, the lower surface of the base plate is concave.

[0016] In some configurations, the stem includes a Morse taper lock above the top of the generally disc-shaped portion of the glenoid baseplate.

[0017] In some configurations, the system further comprises a glenosphere.

[0018] In some configurations, the glenosphere includes an upper dome-shaped surface that includes a rotation control feature configured to enable an insertion tool to lock the glenosphere and the base plate together and rotate the glenosphere and the base plate together.

[0019] In some configurations, the rotation control features include splines.

[0020] In some configurations, the system further includes a central set screw and a locking nut.

[0021] In some configurations, the system further includes a central compression screw non-integral with the base plate and configured to be positioned distally adjacent to the central set screw.

[0022] These drawings are exemplary embodiments and do not represent all possible embodiments of the invention. [Additional note 1] Glenoid baseplate including longitudinal axis Including, the glenoid baseplate further includes a stem and a central channel in a sidewall of the stem, the stem including a longitudinal axis; the longitudinal axis of the glenoid base plate is inclined relative to the longitudinal axis of the stem, and the longitudinal axis of the glenoid base plate is not perpendicular to the longitudinal axis of the stem; the glenoid base plate includes a generally disc-shaped portion extending radially outward from an outer surface of the stem in a radially outward direction of the central channel, and an upper surface of the generally disc-shaped portion is not perpendicular to a longitudinal axis of the stem; the stem includes a sidewall extending along an upper portion of the stem that defines the central channel, and an upwardly extending portion, the upwardly extending portion continuing from the sidewall to an upper surface of the generally disc-shaped portion; A reverse shoulder system wherein the upper surface of the generally disc-shaped portion is parallel to a lower surface of the generally disc-shaped portion. [Additional note 2] 10. The system of claim 1, wherein the glenoid base plate includes a periphery. [Additional note 3] 3. The system of claim 2, wherein the periphery includes spaced anti-rotation features. [Additional note 4] 4. The system of claim 3, wherein the anti-rotation feature includes a slot. [Additional note 5] 3. The system of claim 2, wherein the lower portion of the periphery includes a porous coating. [Additional note 6] 10. The system of claim 1, wherein the lower surface of the generally disc-shaped portion includes a porous coating, but the upper surface does not include a porous coating. [Additional note 7] 3. The system of claim 2, wherein the periphery and / or the underside of the glenoid base plate comprises a conical shape. [Additional note 8] 10. The system of claim 1, wherein the underside of the glenoid base plate is concave. [Additional note 9] 10. The system of claim 1, wherein the stem includes a Morse taper lock above the top of the generally disc-shaped portion of the glenoid base plate. [Additional Note 10] The system of claim 1, further comprising a glenosphere. [Additional Note 11] The system of claim 10, wherein the glenosphere includes an upper dome-shaped surface including a rotation control feature configured to enable an insertion tool to lock the glenosphere and the glenoid base plate together and rotate the glenosphere and the glenoid base plate together. [Additional Note 12] 12. The system of claim 11, wherein the rotation control feature includes a spline. [Additional Note 13] 11. The system of claim 10, further comprising a central set screw and a locking nut. [Additional Note 14] 14. The system of claim 13, further comprising a central compression screw non-integral with the glenoid base plate and configured to be positioned adjacent to and distal to the central set screw. [Brief explanation of the drawings]

[0023] [Figure 1] 1 illustrates one embodiment of the components of a total reverse shoulder system. [Figure 2] 10A-10C illustrate various embodiments of a humeral tray that can be utilized in a total reverse shoulder system, according to some embodiments. [Figure 3] 10A-10C illustrate various humeral bearing components that may be utilized in a total reverse shoulder system, according to some embodiments. [Figure 4] 1A and 1B illustrate schematically one embodiment of a glenoid baseplate configured to be inserted into a glenoid. [Figure 5] 5A and 5B illustrate schematically one embodiment of a glenoid baseplate 500 configured to be inserted into a glenoid. [Figure 6] 10 illustrates a threaded locking insert for the central channel of the stem / post, according to some embodiments. [Figure 7] 1A-1C show various views of a glenosphere, according to some embodiments. [Figure 8] 1 shows a schematic cross-sectional view of a fully assembled glenosphere with locking bolts, according to some embodiments. [Figure 8A] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8B] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8C] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8D] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8E] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8F] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8G] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8H] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8I] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8J] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8K] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8L] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8M] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8N] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8O] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8P] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8Q] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8R] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8S] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8T] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 8U] 1 illustrates a glenoid surgery technique, according to some embodiments. [Figure 9] 1 illustrates one embodiment of a sizer / angle guide. [Figure 10] 1 illustrates one embodiment of a stem drill guide. [Figure 11] Schematic showing a stem angle change with rotation adjustment. [Figure 12] 1A-1C are schematic diagrams showing views of a glenoid baseplate inserter (alone on the left and with a baseplate on the right), according to some embodiments. [Figure 13] 1A and 1B illustrate schematic diagrams of a calibrated central drill, according to some embodiments. [Figure 14]1A-1C schematically illustrate views of a fixed angle peripheral drill guide, according to some embodiments. [Figure 15] 1A-1C schematically illustrate views of a variable angle peripheral drill guide, according to some embodiments. [Figure 16] 1A-1C schematically illustrate side and top views of a central screw, according to some embodiments. [Figure 17] 1A-1C schematically illustrate side and top views of a fixed angle peripheral compression screw, according to some embodiments. [Figure 18] 1A-1C schematically illustrate side and top views of a variable angle peripheral screw, according to some embodiments. [Figure 19] 1A-1C schematically illustrate views of a glenosphere inserter, according to some embodiments. DETAILED DESCRIPTION OF THE INVENTION

[0024] Disclosed herein are various embodiments of a total reverse shoulder system, including, in some embodiments, various humeral trays, humeral bearings, intercalated glenoid baseplates, threaded locking inserts, and glenospheres. Glenoid surgical techniques are also described that can utilize a variety of tools, including, but not limited to, sizer / angle guides, stem drill guides, glenoid baseplate inserters, calibrated central drills, fixed or variable angle peripheral drill guides, central screws, fixed angle peripheral compression screws, variable angle peripheral screws, and glenosphere inserters. The dimensions listed in the accompanying figures are non-limiting examples only.

[0025] FIG. 1 illustrates one embodiment of the components of the overall reverse shoulder system, including a glenosphere 200 and a glenoid baseplate 102, which can be partially or fully inserted in some embodiments. The glenoid baseplate 102 is a generally disc-shaped structure that includes a central opening defining a surface (e.g., integral with the elongated stem) or can be configured to fit an elongated stem or post therethrough. The glenoid baseplate 102 can include a longitudinal axis that is oblique to the longitudinal axis of the elongated stem 100. The longitudinal axis of the glenoid baseplate 102 can be at an angle, such as generally oblique, to the longitudinal axis of the elongated stem 100. In some embodiments, this angle is an acute angle and not a right angle. The angle between the two intersecting longitudinal axes of each base plate 102 and stem 100 can be, for example, about, at least about, or not more than about 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90 degrees, or more or less, or a range including any two of the foregoing values.

[0026] FIG. 2 illustrates various embodiments of humeral trays that can be utilized in a total reverse shoulder system, according to some embodiments. The humeral trays can include various inner and outer diameters, including 30 mm, 32 mm, 34 mm, 36 mm, 38 mm, 40 mm, 42 mm, or greater or lesser ID and / or OD, and ranges including any two of the aforementioned values. The trays can include one or more pegs, such as a central peg, extending from the medial surface. The trays can be neutral or can include extensions (e.g., in thickness), which can be, for example, +2, 4, 6, 8, 10, 12 mm, or ranges including any two of the aforementioned values. The trays can include various cross-sections, including oval or circular cross-sections. The trays can be compatible with the same poly bearing surface in some cases. In some embodiments, one kit can include at least four different sized trays (34mm oval neutral, 34mm oval + 6mm extension, 38mm round neutral, 38mm round + 6mm extension).

[0027] FIG. 3 illustrates various humeral bearing components that can be utilized in a total reverse shoulder system, according to some embodiments, including a humeral tray as illustrated and described in connection with FIG. 2. These bearing components can include, for example, a peripheral ring 302, a central recessed portion that can be outlined radially outward by the inner edge of the peripheral ring, and an inner bowl-shaped portion 304. The peripheral ring can include indicia, such as a slot or other marking 399, that indicates the highest point of the bearing component. Also shown is a recessed polydome 395 and partial or complete annular barbs 397 around the circumference of the bearing component. The bearing component can include various shapes, including angles of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 degrees relative to neutral, horizontal, or a range including any two of the foregoing values. In some embodiments, the bearing component does not alter the center of joint. In some embodiments, the bearing component can include a ball diameter of 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45 mm, or more or less, or a range including any two of the foregoing values. In some embodiments, the systems and methods can include deviations of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 mm, or a range including any two of the foregoing values.

[0028] FIG. 4 schematically illustrates one embodiment of a glenoid baseplate configured to be inserted into a glenoid G as shown. The longitudinal axis of the baseplate can be angled relative to the longitudinal axis of the stem / post, for example, as described with respect to FIG. 1, and can include a version change 499 to compensate for posterior bone defects. In some embodiments, the glenoid baseplate includes a central channel defining a surface therethrough (e.g., integral with the elongated stem) or configured to accommodate the stem / post as shown. The glenoid baseplate can include a generally conical shape with a concave lower surface configured to fit within the reaming surface of the glenoid bone, advantageously allowing for the utilization of a single-turn reamer, as opposed to conventional glenoid baseplates with a flat lower surface that require a two-stage reaming process. The struts 493 can have a length of about, at least about, or not more than about 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15 mm, or more or less, or a range including any two of the aforementioned values. In some embodiments, the central channel and / or stem can include a female Morse taper 497 of about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more or less degrees, including a range incorporating any two of the aforementioned values. As shown in the right diagram of Figure 4, the baseplate can be configured to pivot about the stem / taper at arrow 495 for version correction while allowing direct bone-to-implant interface without requiring augmentation. In some embodiments, the system can be configured to provide a version angle correction of, for example, about 0, 2.5, 5, 7.5, 10, 12.5, 15, 17.5, 20 degrees or more or less, or a range including any two of the foregoing values.In some embodiments, the base plate can have a diameter of about, at least about, or not greater than about 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 mm, or greater or less than, or a range including any two of the foregoing values. The base plate can advantageously pivot about a central stem with a Morse taper for version correction, allowing for a direct bone-to-implant interface.

[0029] FIG. 5 schematically illustrates one embodiment of a glenoid baseplate 500 configured to be inserted into a glenoid (not shown in FIG. 5 ). The longitudinal axis of the baseplate 500 can be angled relative to the longitudinal axis of the stem / post 510, for example, as described with respect to FIGS. 1 and 4 above. The baseplate 500 can have a generally arcuate periphery. The periphery can include spaced anti-rotation slots 521 oriented generally transversely to the longitudinal plane of the baseplate 500. In some embodiments, the periphery of the baseplate 500 can taper (e.g., decrease) in diameter from the top to the bottom dimension. A central channel extends through the baseplate 500 and can include an upwardly extending sidewall or lip 511 somewhat resembling the slope of the side of a volcano. The central channel can define a surface (e.g., integral with the elongated stem) or be configured to accommodate the stem / post 510 therethrough. The base plate 500 may also include a plurality of regularly or irregularly spaced secondary (peripheral) channels 555 spaced radially outward from the central channel of the base plate and configured to accommodate fixed and variable angle screws therethrough. The secondary channels 555 may be asymmetric and may also include an upwardly extending portion 556 that may extend into and block the upwardly extending sidewall or lip 511 of the central channel of the base plate 500. The base plate 500 may include, for example, a porous coating 585 on the entirety or only a portion of the periphery and / or lower surface (e.g., bottom surface) of the base plate 500 to promote bone ingrowth.

[0030] 5 , the stem / post 510 may have an internal taper, such as a Morse taper, of about, at least about, or about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 degrees or less, or a range including any two of the foregoing values. The stem / post 510 may also include a rotation control feature 545 along the outer diameter of the stem / post 510 and, in some embodiments, above the top surface of the sidewall 511 of the central channel of the glenoid baseplate 500 as shown. The rotation control feature 545 may be non-circular or non-arcuate, such as, for example, a hexagonal shape as shown. The stem / post 510 also includes a central channel and may include a Morse taper lock 535 configured to mate with a glenosphere (not shown). The Morse taper lock may extend above the top surface of the sidewall 511 of the central channel of the glenoid baseplate 500. The central channel of the stem / post 510 can be configured to receive a primary screw (not shown) therethrough, which is a variable angle primary screw and can optionally be locked.

[0031] FIG. 6 illustrates a threaded locking insert 600 for a central channel of a stem / post, according to some embodiments. The insert 600 includes external male threads 602 and can be configured to fit into the central channel of a base plate. The insert's outer diameter can also include a hexagonal portion 604 at its upper end of about, at least about, or about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 mm or less, or more or less than, or a range including any two of the aforementioned values. The hexagonal portion 604 can be configured to function as a rotation control feature in some embodiments. The insert 600 can also include internal threads 608 configured to receive a supplemental glenosphere locking screw (not shown) and a spherical surface 612 at its lower end, for example, to lock a variable angle screw.

[0032] 7 shows various views of a glenosphere, according to some embodiments. The image on the left shows a glenosphere with a rotational control feature 702, which may include a spline, such as an asymmetrical spline, advantageously allowing for rotational control about the spline and may be configured to allow an insertion tool to lock and rotate the glenosphere with other components, such as a base plate. The glenosphere may also include one or more indicia, such as an eccentric rotation mark 704. The glenosphere may include a generally dome-shaped surface 714, a cavity 706 with a downward-facing opening 708, and a hollow post including a Morse taper lock 711 into the base plate. The glenosphere may be a full hemisphere or may be shorter than a full hemisphere by a distance 720 of about, at least about, or not more than about 0.5 mm, 0.75 mm, 1 mm, 1.25 mm, 1.5 mm, 1.75 mm, 2 mm, 2.25 mm, 2.5 mm, 2.75 mm, 3 mm, or more or less, or a range including any two of the foregoing values.

[0033] 7 , in some embodiments, the glenosphere can have an articulation diameter of about, at least about, or less than or equal to about 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 mm, or greater or less than, or a range inclusive of any two of the foregoing values. In some embodiments, the systems and methods can include offset and / or eccentricity dimensions of 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 mm, or a range inclusive of any two of the foregoing values. In some embodiments, the glenosphere has a neutral shape. In some embodiments, the glenosphere 724 is offset by, for example, about +3 mm or about 6 mm. In some embodiments, the glenosphere 722 has an eccentricity dimension between about 2 mm and about 4 mm. In some embodiments, a secondary locking screw may be utilized in conjunction with the glenosphere.

[0034] 8 shows a schematic cross-section of a fully assembled glenosphere with a base plate and locking bolts, according to some embodiments. The glenosphere can include a central channel therethrough that includes a rotation control feature 702 at the top, which may be described elsewhere herein, for example. The central channel also includes a threaded surface 808 for an inserter / head extractor, such as below the rotation control feature 702, and can optionally accommodate a secondary locking screw at 810 configured to press against and / or rotate with the posts of the base plate. The posts of the glenosphere can be at least partially positioned within the central channel of the base plate as shown. A central set screw / locking nut 814, for example, is connected to a central channel in the glenoid baseplate, and in some cases is removably attachable, and can have an end adjacent to or directly contacting an end of the central compression screw 816, which can include a diameter of, for example, about, at least about, or not more than about 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10 mm, or more or less, or a range including any two of the foregoing values. The central compression screw can be configured to be angled relative to the baseplate, advantageously allowing for the use of a locking screw.

[0035] 8A-8U illustrate a glenoid surgical technique, according to some embodiments, which may include any number of the following operations: FIG. 8A shows the glenoid surface with an A3-E3 defect. A sizer / angle guide can be placed as in FIG. 8B. A wire guide / wire can be placed as in FIG. 8C. The wire guide and sizer / angle guide can be removed as in FIG. 8D. The glenoid surface can then be reamed for the base plate as in FIG. 8E and FIG. 8F. A stem drill guide can then be placed and adjusted as in FIG. 8G. Holes for the stem can then be drilled as in FIG. 8H and FIG. 8I. A base plate can then be inserted as in FIG. 8J, and the threaded rod can be removed as in FIG. 8K. A central cavity can be drilled as in FIG. 8L, and the length of the central screw to be placed can be determined. The drill can be removed as in FIG. 8M, and a screw and screwdriver can be placed through the shaft, and the screw is tightened as in FIG. 8N. The base plate inserter handle can be removed as in FIG. 8O, and holes can be drilled for peripheral locking screws as in FIG. 8P. As shown in Figure 8Q, holes can be drilled for variable angle screws. In Figure 8R, peripheral screws can be inserted and tightened. In Figure 8S, a central set screw and secondary locking nut can be inserted and tightened. In Figure 8T, a glenosphere can be inserted, and in Figure 8U, a locking bolt can be inserted and tightened.

[0036] 9 shows one embodiment of a sizer / angle guide that includes a tilt-down mechanism 902. This mechanism can be fixed at a set angle (e.g., approximately 0, 5, 10, 15, 20, 25 degrees, or a range including any two of the foregoing values) or is adjustable in some embodiments. This mechanism can be circular or oval shaped in some embodiments and can include a slot (e.g., rear or rear-lower) to allow for removal. The tilt-down mechanism 902 can include a set screw with a calibrated window or, in some cases, a discrete depth screw.

[0037] 10 illustrates an embodiment of a stem drill guide that can include a diameter of about, at least about, or up to about 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 mm, or greater or less, or a range inclusive of any two of the foregoing values. The drill guide can include, for example, a version angle of about 0, 5, 10, 15, 20, 25 degrees, or greater or less, or a range inclusive of any two of the foregoing values. In some embodiments, a larger version angle generates more stem tilt when rotation occurs.

[0038] 11 shows a schematic representation of a stem angle change with rotational adjustment (e.g., about 30 degrees) and a tilted version plate (e.g., about 15 degrees) as a non-limiting example. Anterior-posterior and inferior-superior views are shown.

[0039] 12 shows a schematic view of a glenoid baseplate inserter (alone on the left and with a baseplate on the right), according to some embodiments. The baseplate inserter can be configured with any number of positive rotation controls, a slim design that allows visualization through the screw holes to know when fixation is achieved, and / or a multi-function handle that allows drilling of a central screw hole and insertion of a central screw.

[0040] 13 schematically illustrates a diagram of a calibrated central drill, according to some embodiments. Calibrated marks / indicia 902 at desired spaced increments (e.g., 5 mm increments in some embodiments) near the proximal end of the instrument can aid in determining the length of the central screw that may be required. The calibrated length can start, for example, at about, at least about, or up to about 15 mm, 20 mm, 25 mm, 30 mm, 35 mm, 40 mm, or more or less, including any two of the foregoing values, and can advantageously allow for the elimination of one surgical step.

[0041] 14 is a schematic diagram of a fixed angle peripheral drill guide, according to some embodiments. The drill guide can be configured to fit a polygonal (e.g., octagonal) shape on top of the base plate, allowing the surgeon to decide which fixed angle screws to drill.

[0042] FIG. 15 schematically illustrates a view of a variable angle peripheral drill guide, according to some embodiments.

[0043] 16 schematically illustrates side and top views of a central screw according to some embodiments, including a head 1601, a threaded shaft 1602, and a distal tapered portion. In one embodiment, the screw can have a 6.5 mm head and a 6 mm threaded shaft, although various size ranges and increments are possible, including head and / or threaded shaft diameters of about, at least about, or up to about 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10 mm or less, or more or less, or ranges including any two of the foregoing values. In some embodiments, the central screw can have a total or working length of about, at least about, or about 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70 mm, or more or less, or ranges including any two of the foregoing values. In some embodiments, anodization of the screws may optionally be present to help distinguish the screws. The screw head may have a variety of internal features 1603, including a T20 hexalobe configuration in some embodiments.

[0044] 17 schematically illustrates side and top views of a fixed angle peripheral compression screw according to some embodiments, including a head 1701, double start threads 1703 proximal to a threaded shaft 1702, and a distal tapered portion. The threads can be in various size ranges and increments and can include a T20 hexalobe or other internal head features 1704 as described elsewhere herein. In one embodiment, the head can be approximately 5.7 mm in diameter with a threaded shaft diameter of 4.5 mm, or dimensions listed elsewhere herein, for example, as in connection with FIG. 16.

[0045] 18 schematically illustrates side and top views of a variable angle peripheral screw according to some embodiments, including a head 1801, a threaded shaft 1802, and a distal tapered portion. The screw comes in various size ranges and increments and includes a T20 hexalobe or other internal head feature 1803 as described elsewhere herein. In one embodiment, the head can be approximately 5.7 mm in diameter with a threaded shaft diameter of 4.5 mm, or dimensions listed elsewhere herein, for example, in connection with FIG. 16 or FIG. 17.

[0046] 19 schematically illustrates a view of a glenosphere inserter, according to some embodiments, which may include a distal end with features complementary to the splines on the glenosphere, e.g., as described in connection with FIG. 7. The glenosphere inserter may be configured to allow positive rotational control during insertion, for example, which advantageously provides a secure attachment to the glenosphere, and / or may involve a secondary impaction step after removal.

[0047] In some embodiments, embodiments of the present invention can be used or modified with particular advantage to employ intercalary glenoid fixation techniques in anatomic shoulder arthroplasty, such as those described in U.S. Patent Nos. 8,007,538 and / or 8,778,028 to Gunther, which are incorporated herein by reference in their entireties. Additionally, embodiments of the present invention can be used or modified with systems and methods such as those disclosed in U.S. Patent Application Publication No. 2018 / 0368982 to Ball, which are incorporated herein by reference in their entireties.

[0048] Of course, various other modifications, adaptations, and alternative designs are possible in light of the above teachings. It should therefore be understood at this point that, within the scope of the appended claims, the invention may be practiced otherwise than as specifically described herein. It is contemplated that various combinations or subcombinations of the specific features and aspects of the above-disclosed embodiments may be made and still fall within one or more of the present inventions. Furthermore, any particular feature, aspect, method, property, characteristic, quality, attribute, element, etc., disclosed herein relating to one embodiment may be used in all other embodiments defined herein. It should therefore be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed invention. It is therefore intended that the scope of the invention disclosed herein should not be limited by the specific disclosed embodiments described above. Also, while the invention is susceptible to various modifications and alternative forms, specific examples thereof have been shown in the drawings and are described in detail herein. However, the invention should not be limited to the specific forms or methods disclosed, but rather, it should be understood that the invention covers all modifications, equivalents, and alternatives falling within the spirit and scope of the various described embodiments and the appended claims. Any method disclosed herein does not have to be performed in the order described. The methods disclosed herein include several actions taken by a practitioner, but may also include any third-party direction of these actions, either explicitly or implicitly. For example, an action such as "inserting an implant into a glenoid cavity" includes "instructing insertion of the implant into the glenoid cavity." Ranges disclosed herein also encompass any and all overlaps, subranges, and combinations thereof. Terms such as "up to," "at least," "greater than," "less than," "between," and the like are inclusive of the recited numbers.As used herein, numbers preceded by terms such as "approximately," "about," and "substantially" are inclusive of the recited number (e.g., about 10% = 10%) and represent an amount close to the recited amount that still performs the desired function or achieves the desired result. For example, the terms "approximately," "about," and "substantially" can refer to an amount that is within less than 10%, less than 5%, less than 1%, less than 0.1%, and less than 0.01% of the recited amount. [Explanation of symbols]

[0049] 100 stem 102 base plate 200 Glenosphere 302 Peripheral Ring 304 Inner bowl-shaped part 306 Ring Shield 397 Annular Barb 399 Marking 493 Post 497 Morse Taper 499 version change 500 base plate 510 stem / post 511 Side wall 521 Anti-rotation slot 535 Morse Taper Lock 545 Rotation Control Feature 555 Secondary Channel 556 Upper extension part 585 Porous Coating 600 inserts 602 Male thread 604 Hexagonal part 608 female thread 612 Spherical 702 Rotation Control Feature 704 Eccentric Rotation Mark 706 Cavity 711 Morse Taper Lock 714 Nearly dome-shaped surface 722 Glenosphere 724 Glenosphere 808 thread surface 814 Central Set Screw / Locking Nut 816 Central Compression Screw 902 Downward tilt mechanism 1601 Head 1602 Threaded shaft 1603 Internal feature shape 1701 Head 1702 Threaded shaft 1703 Double thread screw 1704 Internal head feature shape 1801 head 1802 Threaded Shaft 1803 Internal head feature shape

Claims

[Claim 1] 1. A reverse shoulder system, comprising: a glenoid baseplate including a longitudinal axis; the glenoid baseplate further comprises a stem and a central channel in a sidewall of the stem, the stem having a longitudinal axis; A reverse shoulder system, characterized in that the longitudinal axis of the glenoid base plate is inclined relative to the longitudinal axis of the stem, and the longitudinal axis of the glenoid base plate is not perpendicular to the longitudinal axis of the stem.

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