The "Weep-Hole" Technique for Improved Glenoid Fixation

The purpose of this study was to determine if a specially designed suction device, tunneled through a vent hole in the coracoid process to a position deep in the glenoid vault, would eliminate radiolucent lines around the keel of a glenoid component on immediate postoperative radiographs. Literature reviews and cadaver studies were used to develop a predictable anatomic relationship between the medullary canal of the coracoid process and the glenoid vault. Details of these studies were applied to develop an effective surgical procedure. Thirty consecutive total shoulder arthroplasties were preformed, using the keeled appliance from the Zimmer, Bigliani-Flatow™, or the Tonier, Aequalis™, system. The suction device was advanced through a vent in the coracoid process decompressing the glenoid vault. This approach was relatively simple, adding only an average of 6 minutes to the operation, and resulted in no significant complications. In this series only 2 radiolucent lines were noted on the immediate post operative X-rays. One line in zone 2 (the tip of the keel) was less than 1 mm thick, and a second in zone 3 (the inferior limb of the keel) was greater than 2 mm. This surgical technique eliminates most postoperative lucent lines by facilitating the penetration of the cement into the glenoid vault.