Surgical management of the biconcave (B2) glenoid

Donohue, Kenneth W.; Ricchetti, Eric T.; Iannotti, Joseph P.

doi:10.1007/s12178-016-9315-1

Cited by 31 publications

(19 citation statements)

References 44 publications

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“…8,9,11 The surgical treatment of shoulder osteoarthritis in this scenario includes hemiarthroplasty (HA) with or without asymmetric reaming (anterior reaming), TSA with asymmetric reaming, TSA with glenoid bone graft, TSA with augmented glenoid component, or RSA. 19,20 HA provides poor results in the context of eccentric posterior glenoid wear. 9,10 In addition, the outcomes of HA are worse compared to TSA in the presence of posterior glenoid bone loss.…”

Section: Discussionmentioning

confidence: 99%

“…8 Although some authors have advocated HA with eccentric anterior reaming, 21 –23 there are concerns on joint line medialization that could worsen posterior shoulder instability. 19,20 Even in the setting of TSA, eccentric reaming alone is not recommended if glenoid retroversion is greater than 15° or the posterior bone loss is greater than 8 mm. 24 –26 Correction of the glenoid retroversion with eccentric anterior reaming leads to joint line medialization, use of a smaller glenoid component, medial cortex perforation, and medial subsidence.…”

Section: Discussionmentioning

confidence: 99%

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Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study

Alentorn-Geli

Wanderman

Assenmacher

et al. 2018

J Orthop Surg (Hong Kong)

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Purpose: To compare the outcomes of total shoulder arthroplasty (TSA) with posterior capsule plication (PCP) and reverse shoulder arthroplasty (RSA) in patients with primary osteoarthritis, posterior subluxation, and bone loss (Walch B2). Patients and methods: All shoulders undergoing anatomic TSA with PCP were retrospectively identified (group 1, G1) and compared to shoulders undergoing RSA (group 2, G2) for Walch B2 osteoarthritis. There were 15 patients in G1 (mean (SD) age and follow-up of 70.5 (7.5) years and 42.8 (18.4) months, respectively) and 16 patients in G2 (mean (SD) age and follow-up of 72.6 (5.4) years and 35.1 (14.2) months, respectively). Results: Both groups had substantial improvements in pain and function. In G1, results were excellent in 80% and satisfactory in 20%, compared to 81% and 6% in G2, respectively (p ¼ 0.2). The mean (SD) American Shoulder and Elbow Surgeons score was 91.2 (6.7) and 80.3 (14.3) in G1 and G2, respectively (p ¼ 0.08). The mean Simple Shoulder Test score was 10.6 in G1 and 8.5 in G2 (p ¼ 0.01). There were no reoperations in either group, but G1 had seven postoperative complications. Conclusions: The outcomes of TSA with PCP are comparable to RSA in patients with osteoarthritis and biconcave glenoids. However, TSA leads to more complications while RSA leads to lower functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study

Alentorn-Geli

Wanderman

Assenmacher

et al. 2018

J Orthop Surg (Hong Kong)

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“…The reamer was oriented so that reaming yielded a smooth concave surface with a 60-mm diameter of curvature (to match the back of the glenoid component) with the removal of the smallest possible amount of bone, without a specific attempt to normalize glenoid version. For type-B2 glenoids, the crest between the paleoglenoid 48 and the neoglenoid was removed with a burr; the glenoid reamer was then oriented equidistant from the anterior and posterior edges of the glenoid. In cases in which there was a large amount of glenoid retroversion, access for reaming was accomplished by a complete resection of osteophytes, careful retraction of the proximal part of the humerus, and positioning of the arm.…”

Section: Methodsmentioning

confidence: 99%

Anatomic Total Shoulder Arthroplasty with All-Polyethylene Glenoid Component for Primary Osteoarthritis with Glenoid Deficiencies

et al. 2020

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Background: This study evaluated the ability of shoulder arthroplasty using a standard glenoid component to improve patient self-assessed comfort and function and to correct preoperative humeral-head decentering on the face of the glenoid in patients with primary glenohumeral arthritis and type-B2 or B3 glenoids. Methods: We identified 66 shoulders with type-B2 glenoids (n = 40) or type-B3 glenoids (n = 26) undergoing total shoulder arthroplasties with a non-augmented glenoid component inserted without attempting to normalize glenoid version and with clinical and radiographic follow-up that was a minimum of 2 years. The Simple Shoulder Test (SST), the percentage of humeral-head decentering on the glenoid face, and bone ingrowth into the central peg were the main outcome variables of interest. Similar analyses were made for concurrent patients with type-A1, A2, B1, and D glenoid pathoanatomy to determine if the outcomes for type-B2 and B3 glenoids were inferior to those for the other types. Results: The SST score (and standard deviation) improved from 3.2 ± 2.1 points preoperatively to 9.9 ± 2.4 points postoperatively (p < 0.001) at a mean time of 2.8 ± 1.2 years for type-B2 glenoids and from 3.0 ± 2.5 points preoperatively to 9.4 ± 2.1 points postoperatively (p < 0.001) at a mean time of 2.9 ± 1.5 years for type-B3 glenoids; these results were not inferior to those for shoulders with other glenoid types. Postoperative glenoid version was not significantly different (p > 0.05) from preoperative glenoid version. The mean humeral-head decentering on the glenoid face was reduced for type-B2 glenoids from −14% ± 7% preoperatively to −1% ± 2% postoperatively (p < 0.001) and for type-B3 glenoids from −4% ± 6% preoperatively to −1% ± 3% postoperatively (p = 0.027). The rates of bone integration into the central peg for type-B2 glenoids (83%) and type-B3 glenoids (81%) were not inferior to those for other glenoid types. Conclusions: Shoulder arthroplasty with a standard glenoid inserted without changing version can significantly improve patient comfort and function and consistently center the humeral head on the glenoid face in shoulders with type-B2 and B3 glenoids, achieving >80% osseous integration into the central peg. These clinical and radiographic outcomes for type-B2 and B3 glenoids were not inferior to those outcomes for other glenoid types. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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“…More wear and deformity secondary to osteophyte formation make pin placement more difficult. 21 In addition, there is likely a limit to the amount of correction that can be obtained by reaming the anterior, high side. Studies have suggested that reaming can make up for up to 8 mm of bone loss of the posterior glenoid and version corrected up to about 15 .…”

Section: Eccentric Reaming and Anatomic Tsamentioning

confidence: 99%

Eccentric Reaming for B2 Glenoids: History, Preoperative Planning, Surgical Technique, and Outcome

Smith

Loftis

Skelley

2019

Journal of Shoulder and Elbow Arthroplasty

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Background: The biconcave (B2) glenoid is characterized by preservation of the anterior portion of the native glenoid with asymmetric wear of the posterior glenoid. Surgical options for glenoid correction have evolved. The goal of shoulder arthroplasty is to place the implants in such a manner to return the humeral head to a centered position and restore the joint line to a neutral position. There is no current consensus on method of treatment and correction. Methods: The current and historical literature on total shoulder arthroplasty was used to examine technique viability. Results: Asymmetric remaining can be used to address up to 15 of version correction without compromise of cortical bone. It is important to have the proper presurgical planning, to understand the limitations of correction, and to have other options available to treat the biconcave glenoid.

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Surgical management of the biconcave (B2) glenoid

Cited by 31 publications

References 44 publications

Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study

Anatomic total shoulder arthroplasty with posterior capsular plication versus reverse shoulder arthroplasty in patients with biconcave glenoids: A matched cohort study

Anatomic Total Shoulder Arthroplasty with All-Polyethylene Glenoid Component for Primary Osteoarthritis with Glenoid Deficiencies

Eccentric Reaming for B2 Glenoids: History, Preoperative Planning, Surgical Technique, and Outcome

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