B2 Glenoid in the Active 50-Year-Old With Severe Glenohumeral Osteoarthritis: It's So Confusing! What Should I Do?

Abstract

In the young, active patient with osteoarthritis, the optimal treatment of B2 glenoid morphology remains a subject of continued debate. Current treatment options have specific advantages and disadvantages. These treatments include hemiarthroplasty with or without glenoid reaming, total shoulder arthroplasty (TSA) with or without eccentric reaming, TSA with bone graft or posteriorly augmented glenoid implant, and reverse TSA. Eccentric glenoid reaming can be effective but has the risk of excessive reaming of subchondral bone for greater retroversion deformities, compromising implant purchase with the risk of future subsidence and diminished remaining bone stock for future revision. Bone graft augmentation, although a technically challenging procedure, can be effective in select patients with excellent bone quality, but has a high risk of postoperative complications. Posteriorly augmented anatomic glenoid components can correct glenoid version while maintaining native bone stock, presenting an intriguing option for further research. Finally, the long-term success of an anatomic total shoulder relies on version and inclination correction and preservation of subchondral bone, while maintaining stability. If all three of these parameters cannot be adequately achieved, then reverse TSA may be the best option: this treatment is a more stable construct that is more tolerant to glenoid deformity, loss of glenoid bone stock, and muscular imbalance.