阅读说明：本技术 全反向肩部系统和方法 (Full reverse shoulder system and method ) 是由 唐纳德·E·朗宁 罗伯特·J·巴尔 杰森·斯隆 于 2020-03-11 设计创作，主要内容包括：反向肩部系统可包括例如包括纵向轴线的关节盂基板,该关节盂基板进一步包括杆和在杆的侧壁内的中心通道。该杆可以包括纵向轴线。该关节盂基板的纵向轴线可以相对于该杆的纵向轴线成角度,其中该关节盂基板的纵向轴线不垂直于该杆的纵向轴线。还公开了包括关节盂球的其他部件、工具和使用方法。(The reverse shoulder system may include, for example, a glenoid baseplate including a longitudinal axis, the glenoid baseplate further including a stem and a central channel within a sidewall of the stem. The rod may include a longitudinal axis. The longitudinal axis of the glenoid baseplate may be angled relative to the longitudinal axis of the stem, wherein the longitudinal axis of the glenoid baseplate is non-perpendicular to the longitudinal axis of the stem. Other components, tools, and methods of use, including glenospheres, are also disclosed.)

1. A reverse shoulder system comprising:

a glenoid baseplate including a longitudinal axis,

the glenoid baseplate further includes a stem including a longitudinal axis and a central channel in a sidewall of the stem,

wherein the longitudinal axis of the glenoid baseplate is angled relative to the longitudinal axis of the stem, wherein the longitudinal axis of the glenoid baseplate is non-perpendicular relative to the longitudinal axis of the stem.

2. The system of claim 1, wherein the glenoid baseplate includes a generally disc-shaped portion extending radially outward from the central passage.

3. The system of claim 2, wherein the rod includes a sidewall extending upwardly relative to the dished portion.

4. The system of claim 1, wherein the glenoid baseplate includes a peripheral edge.

5. The system of claim 4, wherein the peripheral edge comprises spaced anti-rotation features.

6. The system of claim 5, wherein the anti-rotation feature comprises a slot.

7. The system of claim 4, wherein a lower portion of the peripheral edge comprises a porous coating.

8. The system of claim 1, wherein the lower surface of the generally disc-shaped portion includes the porous coating, but the upper surface does not include the porous coating.

9. The system of claim 4, wherein the peripheral edge and/or lower surface of the substrate comprises a tapered geometry.

10. The system of claim 1, wherein the lower surface of the substrate is concave.

11. The system of claim 1, wherein the lever comprises a morse taper lock located above an uppermost portion of the generally disc-shaped portion of the glenoid baseplate.

12. The system of claim 1, further comprising a glenosphere.

13. The system of claim 12, wherein the glenosphere includes an upper domed surface including a rotation control feature configured such that an inserter tool can lock the glenosphere and the baseplate to allow the glenosphere and baseplate to rotate together.

14. The system of claim 13, wherein the rotational control feature comprises a spline.

15. The system of claim 12, further comprising a central set screw and a locking nut.

16. The system of claim 15, further comprising a central compression screw that is non-integral with the base plate and configured for placement adjacent and distal to the central set screw.

Background

The present application claims benefit of U.S. provisional application No.62/816,708 as a U.S. provisional application in accordance with 35u.s.c. § 119 (e). The entire contents of this application are incorporated herein by reference.

Shoulder replacement is a common medical procedure used to treat osteoarthritis, rheumatoid arthritis, and to treat certain deformities associated with oncological indications and trauma. There are two main types of joints that the surgeon can treat: anatomical joints and reverse joints. Anatomically, surgeons replace joint surfaces with industrial materials so that the joint surfaces have substantially the same shape as the natural anatomy. The stem can be fixed generally within the humeral canal and a metallic articular head can be rigidly fixed to the proximal side of the humeral canal, the head having a convex articular surface adapted to articulate with the glenoid implant. The glenoid implant can include on its posterior (medial) side certain pegs or posts or fins adapted to be rigidly fixed within the glenoid fossa of the scapula, and on its anterior side a concave or flat articular surface adapted to articulate with the humeral head of the humeral implant.

When a reverse prosthesis is used, the articular surfaces are reversed in that the metal ball is rigidly fixed to the glenoid fossa of the scapula and the concave articular surface is rigidly fixed to the humerus, thereby reversing the manner of articulation of the prosthesis.

The surgeon selects between the two types of prostheses by evaluating the patient's various conditions including the level of pain, the level of patient activity, deformity or severity of bone degeneration, the strength of the surrounding soft tissue, and the presence or absence of prior surgery, particularly the health and strength of the rotator cuff muscles and tendons. Rotator cuff disease is common in patients with shoulder arthritis. In this case, it is generally observed that the absence of insufficient rotator cuff leads to a situation in which the anatomical shoulder replacement prosthesis is not sufficiently stabilized by the surrounding soft tissue. In such cases, reverse shoulder replacement prostheses may be preferred in some cases due to the higher inherent stability of the joint. In addition, by adjusting the position of the articular surface within the joint, the reverse prosthesis may advantageously utilize the remaining muscles in a more efficient manner without other soft tissue structures.

Disclosure of Invention

In some embodiments, disclosed herein is a reverse shoulder system comprising any number of glenoid baseplates, the glenoid baseplates comprising a longitudinal axis, the glenoid baseplates further comprising a stem comprising a longitudinal axis and a central channel within a sidewall of the stem. The longitudinal axis of the glenoid baseplate may be angled relative to the longitudinal axis of the stem, wherein the longitudinal axis of the glenoid baseplate is non-perpendicular to the longitudinal axis of the stem.

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

In some configurations, the stem includes a sidewall extending upwardly relative to the disc-shaped portion.

In some configurations, the glenoid baseplate includes a peripheral edge.

In some constructions, the peripheral edge includes spaced anti-rotation features.

In some constructions, the anti-rotation feature includes a slot.

In some configurations, a lower portion of the peripheral edge includes a porous coating.

In some configurations, the lower surface of the generally disc-shaped portion includes the porous coating, but the upper surface does not include the porous coating.

In some configurations, the peripheral edge and/or the lower surface of the substrate comprises a tapered geometry.

In some configurations, the lower surface of the substrate is concave.

In some configurations, the stem includes a morse taper lock located above an uppermost portion of the generally disc-shaped portion of the glenoid baseplate.

In some configurations, the system further comprises a glenosphere.

In some configurations, the glenosphere includes an upper domed surface including a rotation control feature configured such that an insert tool can lock the glenosphere and the baseplate to allow the glenosphere and baseplate to rotate together.

In some configurations, the rotational control feature comprises a spline.

In some configurations, the system further comprises a central set screw and a locking nut.

In some configurations, the system further includes a central compression screw that is not integral with the base plate and is configured for placement adjacent and distal to the central set screw.

Drawings

The drawings are illustrative of embodiments and do not represent all possible embodiments of the invention.

Fig. 1 shows an embodiment of components of a full reverse shoulder system.

Fig. 2 illustrates various embodiments of a humeral tray that can be used with a full reverse shoulder system according to some embodiments.

Fig. 3 illustrates various humeral bearing components that can be used with a full reverse shoulder system, according to some embodiments.

Fig. 4 schematically illustrates an embodiment of a glenoid baseplate configured to be inserted into a glenoid.

Fig. 5 schematically illustrates an embodiment of a glenoid baseplate 500 configured to be inserted into a glenoid.

Fig. 6 illustrates a threaded locking insert for a central passage of a rod/post according to some embodiments.

Fig. 7 illustrates various views of a glenosphere according to some embodiments.

Fig. 8 shows a schematic cross-section of a fully assembled glenosphere with a locking bolt according to some embodiments.

Figures 8A-8U illustrate a glenoid surgical technique according to some embodiments.

Fig. 9 shows an embodiment of the sizer/angle guide.

Figure 10 illustrates an embodiment of a rod drill guide.

Fig. 11 schematically shows a change in the lever angle with rotational adjustment.

Fig. 12 schematically illustrates a view of a glenoid baseplate insert (left side alone and right side with baseplate) according to some embodiments. .

FIG. 13 schematically illustrates a view of a calibrated center drill, according to some embodiments. .

Figure 14 schematically illustrates a view of a fixed angle peripheral drill guide according to some embodiments. .

Fig. 15 schematically illustrates a view of a variable angle peripheral drill guide according to some embodiments.

Fig. 16 schematically illustrates a side view and a top view of a center screw according to some embodiments.

Fig. 17 schematically illustrates a side view and a top view of a fixed angle peripheral compression screw, in accordance with some embodiments.

Fig. 18 schematically illustrates side and top views of a variable angle peripheral screw according to some embodiments.

Fig. 19 schematically illustrates a view of a glenosphere insert according to some embodiments.

Detailed Description

In some embodiments, disclosed herein are various embodiments of a full reverse shoulder system, including various humeral trays, humeral bearings, glenoid baseplate insert, threaded locking inserts, and glenospheres. Glenoid surgical techniques are also described that can utilize a variety of tools including, but not limited to, a sizer/angle guide, a rod drill guide, a glenoid baseplate insert, a calibrated center drill, a peripheral drill guide with a fixed or variable angle, a center screw, a fixed angle peripheral compression screw, a variable angle peripheral screw, and a glenosphere insert. The dimensions listed in the figures are only non-limiting examples.

Fig. 1 shows an embodiment of components of a fully inverted shoulder system, including glenosphere 200 and glenoid baseplate 102 that may be partially or fully inserted in some embodiments. Glenoid base plate 102 can be a generally disc-shaped structure and include a central aperture that defines a surface of (e.g., is integral with) an elongated stem or post, or is configured to fit an elongated stem or post therethrough. Glenoid base plate 102 may include a longitudinal axis that is at an angle to the longitudinal axis of elongate stem 100. The longitudinal axis of glenoid base plate 102 may be angled, e.g., generally oblique, relative to the longitudinal axis of elongate stem 100. In some embodiments, the angle is an acute angle, rather than a right angle. The angle between two intersecting longitudinal axes of the respective base 102 and bar 100 can be, for example, about, at least about, or no 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 an angle comprising a range of any two of the foregoing values.

Fig. 2 illustrates various embodiments of a humeral tray that can be used with a full reverse shoulder system according to some embodiments. The humeral tray can include various inner and outer diameters IDS, ODS, including 30mm, 32mm, 34mm, 36mm, 38mm, 40mm, 42mm or greater or lesser IDS and/or ODS, as well as ranges including any two of the foregoing values. The tray may include one or more pegs, such as a central peg extending from the inside surface. The tray may be neutral or include an extension (e.g., in thickness) that may be, for example, +2mm, 4mm, 6mm, 8mm, 10mm, 12mm, or a range including any two of the foregoing values. The tray may include various cross-sections, including an oval or circular cross-section. In some cases, the tray may be compatible with the same multi-bearing surface. In some embodiments, a kit may include at least four different sized trays (34mm oval neutral tray, 34mm oval +6mm extended tray, 38mm round neutral tray, 38mm round +6mm extended tray).

Fig. 3 illustrates various humeral bearing components that can be used with the full reverse shoulder system, including a humeral tray as shown and described in connection with fig. 2, according to some embodiments. The bearing component may include, for example, a peripheral ring 302 and a central recessed portion that may be contoured radially outward from an inner edge of the peripheral ring, and an inner bowl portion 304. The peripheral ring may comprise markings such as grooves or other markings 399 showing the highest point of the bearing component. Also shown are a concave polymeric dome 395, and a partial or complete annular barb 397 surrounding the outer circumference of the bearing component. The bearing component may comprise various geometries, including neutral, 1, 2, 3, 4, 5, 6,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 degrees relative to horizontal, or an angle comprising a range of any two of the foregoing values. In some embodiments, the bearing component does not change the joint center. In some embodiments, the bearing component may comprise a spherical diameter of 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45mm or more or less, or a range comprising any two of the foregoing values. In some embodiments, the systems and methods may include an offset of 1, 2, 3, 4, 5, 6,7, 8, 9, or 10mm, or a range including any two of the foregoing values.

Fig. 4 schematically illustrates an embodiment of a glenoid baseplate configured to be inserted into glenoid G as shown. The longitudinal axis of the base plate may be angled relative to the longitudinal axis of the rod/post, e.g., as described with respect to fig. 1, and may include a version change 499 to compensate for posterior bone defects. In some embodiments, the glenoid baseplate includes a central channel therethrough that defines a surface of the stem/post as shown (e.g., integral with the elongate stem), or is configured and adapted to be configured to receive the stem/post. In contrast to conventional glenoid baseplates with flat inferior surfaces that require a two-step reaming process, the glenoid baseplate may include a generally conical shape with a concave inferior surface configured to rest within the reaming surface of the glenoid bone, which advantageously allows for the use of a single rotary reamer. The posts 493 may have a length of about, at least about, or no more than about 5mm, 5.5mm, 6mm, 6.5mm, 7mm, 7.5mm, 8mm, 8.5mm, 9mm, 9.5mm, 10mm, 10.5mm, 11mm, 11.5mm, 12mm, 12.5mm, 13mm, 13.5mm, 14mm, 14.5mm, 15mm, or more, or less, or a range including any two of the foregoing values. In some embodiments, the central passage and/or stem may include a concave morse taper 497 of about 1, 2, 3, 4, 5, 6,7, 8, 9, 10 degrees or more or less, including ranges encompassing any two of the foregoing values. As shown in the right illustration of fig. 4, the base plate may be configured to pivot about the rod/taper at arrow 495 for version correction and to allow a direct bone-implant interface without reinforcement. In some embodiments, the system can be configured to provide twist angle corrections of, for example, about 0 degrees, 2.5 degrees, 5 degrees, 7.5 degrees, 10 degrees, 12.5 degrees, 15 degrees, 17.5 degrees, 20 degrees or more or less, or a range including any two of the foregoing values. In some embodiments, the diameter of the substrate can be about, at least about, or no 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, 40mm, or greater or less, or a range comprising any two of the foregoing values. The baseplate may advantageously pivot about a central rod with a morse taper to make revision and allow for a direct bone-implant interface.

Fig. 5 schematically illustrates an embodiment of a glenoid baseplate 500 configured to be inserted into a glenoid (not shown in fig. 5). The longitudinal axis of the base plate 500 may be angled relative to the longitudinal axis of the stem/post 510, e.g., as described above with respect to fig. 1 and 4. The substrate 500 may have a generally arcuate peripheral edge. The peripheral edge may include spaced anti-rotation slots 521 oriented generally transverse to the longitudinal plane of the base plate 500. In some embodiments, the diameter of the peripheral edge of the substrate 500 may taper (e.g., decrease) from the upper dimension to the lower dimension. The central channel may extend through the substrate 500 and include upwardly extending sidewalls or lips 511 that somewhat resemble the side slopes of a volcano. The central channel may define a surface of the rod/post 510 therethrough (e.g., integral with the elongated rod), or be configured and adapted to be configured to receive the rod/post 510 therethrough. The substrate 500 may also include a plurality of regularly or irregularly spaced auxiliary (peripheral) channels 555 that are spaced radially outward from the central channel of the substrate and configured to receive fixed angle and variable angle screws therethrough. The auxiliary channel 555 can be asymmetric and include an upper extension 556, and the upper extension 556 can extend into the upper extending sidewall or lip 511 of the central channel of the substrate 500 and interrupt the upper extending sidewall or lip 511 of the central channel of the substrate 500. For example, the substrate 500 can include a porous coating 585 on all or only a portion of the peripheral edge and/or a lower surface (e.g., lower surface) of the substrate 500 to promote bone ingrowth.

Still referring to fig. 5, the rod/post 510 can have an internal taper (e.g., morse taper) of about, at least about, or no greater than about 1, 2, 3, 4, 5, 6,7, 8, 9, 10, 11, 12, 13, 14, 15 degrees or more or less, or a range including any two of the foregoing values. Stem/post 510 may also include rotation control features 545 along the outer diameter of stem/post 510 and, in some embodiments, above the uppermost surface of sidewall 511 of the central channel relative to glenoid baseplate 500, as shown. The rotation control features 545 may be non-circular or non-arcuate, such as, for example, the hexagonal shape shown. The stem/post 510 may also include a central channel and include a morse taper 535 configured to mate with a glenosphere (not shown). The morse taper lock may extend upward relative to an uppermost surface of a sidewall 511 of the central channel of glenoid baseplate 500. The central channel of the rod/post 510 may be configured to receive a main screw (not shown) therethrough, which may be a variable angle main screw, and optionally lock.

Fig. 6 illustrates a threaded locking insert 600 for a central passage of a rod/post according to some embodiments. The insert 600 may include external male threads 602 and be configured to enter into the central passage of the base plate. The outer diameter of the insert may also include a hexagonal geometry portion 604 at the upper end, the hexagonal geometry portion 604 being about, at least about, or no more than about 1, 2, 3, 4, 5, 6,7, 8, 9, 10mm or more or less, or a range including any two of the foregoing values. In some embodiments, the hexagonal geometry portion 604 may be configured to act as a rotation control feature. Insert 600 may also include internal threads 608 configured to receive a supplemental glenosphere locking screw (not shown), and a spherical surface 612, for example, at a lower end thereof to lock the variable angle screw.

Fig. 7 illustrates various views of a glenosphere according to some embodiments. The left figure illustrates a glenosphere having a rotation control feature 702, which rotation control feature 702 can include a spline (such as an asymmetric spline) and is configured to advantageously allow rotation control around the spline and to allow an insert tool to lock and rotate the glenosphere with another component, such as a baseplate. The glenosphere can also include one or more markers, such as an eccentric rotation marker 704. The glenosphere may include a generally dome-shaped surface 714, a cavity 706 with a downwardly facing opening 708, and a hollow cylinder including a morse taper 711 into the baseplate. The glenosphere can be a full hemisphere, or a distance 720 that is about, at least about, or no greater than about 0.5mm, 0.75mm, 1mm, 1.25mm, 1.5mm, 1.75mm, 2mm, 2.25mm, 2.5mm, 2.75mm, 3mm or more or less than a full hemisphere, or a range including any two of the foregoing values.

Still referring to fig. 7, in some embodiments, the glenosphere can include an articulation diameter of about, at least about, or no more than 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, 50mm or more or less, or a range including any two of the foregoing values. In some embodiments, the systems and methods may include an offset and/or eccentricity dimension of 1, 2, 3, 4, 5, 6,7, 8, 9, or 10mm, or a range including any two of the foregoing values. In some embodiments, the glenosphere has a neutral geometry. In some embodiments, glenosphere 724 is offset by, for example, about +3mm or about 6 mm. In some embodiments, glenosphere 722 has an eccentric dimension of between about 2mm and about 4 mm. In some embodiments, a secondary locking screw may be used with the glenosphere.

Fig. 8 shows a schematic cross section of a fully assembled glenosphere with a locking bolt and baseplate according to some embodiments. The glenosphere can include a central passage therethrough that includes a rotation control feature 702 at an uppermost portion, for example, as can be described elsewhere herein. The central channel may also include a threaded surface 808 for the insert/head extractor (such as below the rotation control feature 702) and optionally be configured to receive a secondary locking screw at 810 to push and/or rotate with the post of the substrate. The posts of the glenosphere can be placed at least partially within the central channel of the baseplate, as shown. The central fixation screw/locking nut 814 may be connected to, and in some cases removably attached to, for example, a central channel of the glenoid baseplate, and has an end adjacent to or in direct contact with an end of the central compression screw 816, the central compression screw 816 may include, for example, a diameter of about, at least about, or no greater than about 4mm, 4.5mm, 5mm, 5.5mm, 6mm, 6.5mm, 7mm, 7.5mm, 8mm, 8.5mm, 9mm, 9.5mm, 10mm, or greater or lesser, or a range including any two of the foregoing values. The central compression screw may be configured to be angled relative to the base plate and advantageously allows for the use of a locking screw.

Fig. 8A-8U illustrate a glenoid surgical technique that may include any number of the following actions, according to some embodiments. Fig. 8A shows a glenoid surface having a defect of a 3-E3. The sizer/angle guide can be placed as in fig. 8B. In fig. 8C a wire guide/wire may be placed. As shown in fig. 8D, the wire guide and the sizer/angle guide may be removed. The glenoid surface may then be reamed for the baseplate as shown in fig. 8E and 8F. The rod drill guide may then be placed and adjusted in fig. 8G. Holes for the rods may then be drilled in fig. 8H and 8I. The substrate may then be inserted as shown in fig. 8J and the threaded rod removed as shown in fig. 8K. In fig. 8L, a central cavity may be drilled and the length of the central screw to be placed determined. In fig. 8M the drill bit may be removed and in fig. 8N the screw and screw driver are placed through the shaft and the screw is tightened. The substrate insert handle may be removed in fig. 8O and a hole may be drilled for the perimeter locking screw in fig. 8P. Variable angle screws may be drilled as shown in fig. 8Q. In fig. 8R, peripheral screws may be inserted and tightened. In fig. 8S, a central set screw and a secondary lock nut may be inserted and tightened. The glenosphere can be inserted in fig. 8T and the locking bolt inserted and tightened in fig. 8U.

Fig. 9 illustrates an embodiment of a sizer/angle guide that includes a lower tilt mechanism 902. In some embodiments, the mechanism may be fixed to a set angle (e.g., about 0, 5, 10, 15, 20, 25 degrees, or a range including any two of the foregoing values), or may be adjustable. In some embodiments, the mechanism may be circular or oval and include a slot (e.g., a rear portion or a lower portion of the rear portion) to allow removal. The lower tilt mechanism 902 may include a set screw with an alignment window, or in some cases a separate depth screw.

Fig. 10 illustrates an embodiment of a rod drill guide that may include a diameter of about, at least about, or no more than about 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40mm or more or less, or a range including any two of the foregoing values. The drill guide may include a twist angle of, for example, about 0 degrees, 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, or more or less, or a range including any two of the foregoing values. In some embodiments, the greater the twist angle, the greater the rod tilt that occurs when rotation occurs.

Fig. 11 schematically illustrates a lever angle change and angled version plate (e.g., about 15 degrees) with rotational adjustment (e.g., about 30 degrees) as a non-limiting example. Front-rear and lower-upper views are shown.

Fig. 12 schematically illustrates a view of a glenoid baseplate insert (left side alone and right side with baseplate) according to some embodiments. The substrate insert may be configured for any number of: controlling positive rotation; an elongated design allowing visualization through screw holes to know when to install; and/or a multi-function handle allows for drilling a central screw hole and inserting a central screw.

FIG. 13 schematically illustrates a view of a calibrated center drill, according to some embodiments. Calibration marks/indicia 902 at desired increments (e.g., 5mm increments in some embodiments) spaced near the proximal end of the instrument may help determine the length of the central screw that may be needed. The calibration length may begin, for example, from about, at least about, or no greater than about 15mm, 20mm, 25mm, 30mm, 35mm, 40mm, or more or less (including any two of the foregoing values), and may advantageously allow for the removal of a surgical step.

Figure 14 schematically illustrates a view of a fixed angle peripheral drill guide according to some embodiments. The drill guide may be configured to fit on a geometric shape, such as a polygonal portion (e.g., an octagon) on top of the base plate, and the operator may then determine which fixed angle screws to drill.

Fig. 15 schematically illustrates a view of a variable angle peripheral drill guide according to some embodiments.

Fig. 16 schematically illustrates side and top views of a central screw including a head 1601, a threaded shaft 1602, and a distal tapered portion, according to some embodiments. In one embodiment, the screw may have a 6.5mm head and a 6mm threaded shaft, although various dimensional ranges and increments are possible, including head and/or threaded shaft diameters of about, at least about, or no more than about 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10mm or more or less, or ranges including any two of the foregoing values. In some embodiments, the central screw can comprise an overall length or working length of about, at least about, or no more than about 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70mm or more or less, or a range comprising any two of the foregoing values. In some embodiments, there may optionally be anodization of the screw to help distinguish the screws. The screw head may have various internal feature geometries 1603, including a T20 hex configuration in some embodiments.

Fig. 17 schematically illustrates side and top views of a fixed angle peripheral compression screw including a head 1701, a double lead thread 1703 proximal to a threaded shaft 1702, and a distal tapered portion, according to some embodiments. The screw may be of various size ranges and increments and include a T20 hex or other internal head feature geometry 1704 as described elsewhere herein. In one embodiment, the head may be about 5.7mm in diameter, the threaded shaft 4.5mm in diameter, or the dimensions listed elsewhere herein (e.g., in connection with fig. 16).

Fig. 18 schematically illustrates side and top views of a variable angle peripheral screw including a head 1801, a threaded shaft 1802, and a distal tapered portion, according to some embodiments. The screws may be of various size ranges and increments and include T20 hex or other internal head feature geometry 1803, as described elsewhere herein. In one embodiment, the head may be about 5.7mm in diameter, the threaded shaft 4.5mm in diameter, or the dimensions listed elsewhere herein (e.g., in connection with fig. 16 or 17).

Fig. 19 schematically illustrates a view of a glenosphere insert according to some embodiments, which may include a distal end having features complementary to splines on a glenosphere, such as described in connection with fig. 7. The glenosphere insert may be configured, for example, to advantageously provide a positive attachment with the glenosphere; allowing for robust rotational control upon insertion; and/or may involve a secondary tightening step after removal.

In some embodiments, embodiments of the present invention may be used or modified in anatomical shoulder arthroplasty using the particular advantages of the embedded glenoid fixation technique, such as described in U.S. patent numbers 8,007,538 and/or 8,778,028 to Gunther (which are incorporated herein by reference in their entirety). Further, embodiments of the present invention may be used or modified with systems and methods such as those disclosed in U.S. publication No. 2018/0368982 to Ball, which is incorporated herein by reference in its entirety.

Various other modifications, adaptations, and alternative designs are certainly possible in light of the above teachings. It is, therefore, to be understood 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 embodiments disclosed above may be made and still fall within one or more of the inventions. Moreover, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, etc. in connection with an embodiment can be used in all other embodiments set forth herein. Thus, it should 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 inventions. Thus, the scope of the invention disclosed herein should not be limited by the particular disclosed embodiments described above. In addition, while the invention is susceptible to various modifications and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the invention is not to be limited to the particular forms or methods disclosed, but to the contrary, the invention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the various embodiments described and the appended claims. Any methods disclosed herein need not be performed in the order recited. The methods disclosed herein include certain actions taken by the practitioner; however, it may also include any third party instructions for those actions, either explicitly or implicitly. For example, actions such as "insert implant into glenoid" include "indicate insert implant into glenoid". The ranges disclosed herein further include any and all overlaps, sub-ranges, and combinations thereof. Language such as "up to," "at least," "greater than," "less than," "between," and the like includes the recited number. As used herein, a number preceded by a term such as "about", and "substantially" includes the stated number (e.g., about 10% ═ 10%), and also represents an amount close to the stated amount, which still performs the desired function or achieves the desired result. For example, the terms "about," "about," and "substantially" may refer to an amount within less than 10%, within less than 5%, within less than 1%, within less than 0.1%, and within less than 0.01% of the recited amount.