Are we overthinking the B2 glenoid? Managing the shoulder arthritis with posterior decentering in an active patient.

An active man in his mid 60's presented with pain and stiffness of his right shoulder. Previously he had an arthroscopic posterior labral repair. On examination his shoulder was stiff with crepitance on motion. His x-rays at that time showed posterior decentering of the humeral head on the axillary "truth" view (see this link) and mild arthritis

He elected non-operative management.

Several years later he returned with increasing symptoms including 6-8 pain, the inability to sleep because of shoulder pain, and these x-rays showing severe glenohumeral arthritis, posterior decentering of the humeral head on the glenoid, posterior glenoid bone loss, and 20 degrees of retroversion - a B2 glenoid.

The surgical options included a standard glenoid component with "corrective glenoid reaming", a posteriorly augmented glenoid component, an inset glenoid component and a reverse total shoulder. Because of his active life style and his desire to avoid the risks and limitations associated with the plastic glenoid used in total shoulder arthroplasty, he elected to proceed with a ream and run procedure (see this link).

The glenoid was reamed conservatively to create a single concavity without attempt to change glenoid version. A standard humeral stem was secured with impaction grafting (see this link). An anteriorly eccentric humeral head component was used to manage the posterior decentering of the humeral head on the glenoid (see this link).

Two years after surgery his shoulder was painless with excellent range of motion. He was returning to throwing overhand, which he'd been unable to do for the prior 15 years.

His radiographs showed a secure humeral stem with the anteriorly eccentric humeral head component centered in the mature, regenerated glenoid surface.

Comment: Currently much effort is being directed at techniques evaluating and managing the retroverted glenoid with posterior bone loss and posterior humeral head decentering. Ongoing clinical research will illuminate the advantages, disadvantages, and risks of different surgical approaches. In selected cases, such as this one, the B2 glenoid can be successfully managed without preoperative CT scans and planning, special glenoid components, or intraoperative navigation.

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).