A 40 year old very physically active man presented with pain, stiffness and feelings of instability of the right shoulder. His axially "truth" view showed almost complete posterior decentering of the huneral on a retroverted biconcave glenoid.
No additional imaging was deemed necessary.
The surgical options for this patient would seem to include (1) anatomic total shoulder without or with an augmented glenoid component, (2) reverse total shoulder, or (3) a ream and run procedure.
Because of his active lifestyle and young age, he wished to avoid the risks and limitations of a glenoid component and selected the ream and run option. After non-corrective glenoid reaming, an impaction-grafted smooth stem with an anteriorly eccentric humeral head was used to re-center the humeral head on the reamed glenoid,
He came back to the office fourteen years after his ream and run procedure reporting full function of this shoulder for all this athletic activities. His 14 year films (below) show centering of the anteriorly eccentric humeral head on the glenoid with no evidence of glenoid wear or erosion.
Now at the age of 54 he desires a ream and run for his progressively symptomatic left shoulder.
Since many patients are now using AI queries to answer health questions, I asked ChatGPT, "what is the best treatment for a severe B2 glenoid in an active 40 year old man?"
"I said:
what is the best treatment for a severe B2 glenoid in a 40 year old active man
ChatGPT said:
A severe B2 glenoid in a 40-year-old active man is one of the most challenging scenarios in shoulder arthroplasty. The goals in this patient are (1) durable correction of posterior subluxation, (2) preservation of bone stock, and (3) avoidance of early component loosening or the need for revision while maintaining activity tolerance.
Here’s how current thinking and evidence break down:
1. Joint Preservation vs. Arthroplasty
* Joint-preserving options (e.g., posterior bone grafting, biologic resurfacing, corrective osteotomy) have historically had poor mid- to long-term outcomes and high revision rates. They are rarely used in this age group today except in very select situations (e.g., low-demand, early arthritis).
* For a 40-year-old active patient, most surgeons will lean toward some form of anatomic arthroplasty if the rotator cuff is intact.
2. Anatomic TSA Options
A. Eccentric Reaming
* Indicated if posterior bone loss is <15° retroversion and correction can be achieved without excessive subchondral bone removal.
* In severe B2 (often >15–20° retroversion), eccentric reaming risks medialization, joint line shift, and instability.
B. Augmented Glenoid Components
* Posteriorly augmented polyethylene glenoid (e.g., stepped or wedge) corrects version without excessive reaming.
* Early/midterm studies: improved stability and function, lower risk of loosening compared with eccentric reaming.
* Limitation: long-term durability in young active patients remains under investigation.
C. Bone Grafting
* Posterior structural bone grafting with a standard glenoid component can restore version while preserving bone.
* Historically high risk of graft resorption and loosening, but newer techniques with rigid fixation have shown improved results.
* Best reserved for younger patients where bone preservation is paramount.
3. Reverse TSA
* Reverse is sometimes proposed in severe B2, especially in older patients or when cuff integrity is uncertain.
* In a 40-year-old active man with intact cuff, reverse is generally avoided because of concerns about implant longevity, scapular notching, and difficulty revising to another option later in life.
Sometimes the simplest solution is best
Female House Finch
Matsen Back Yard
2022
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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).
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
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).
You said:
ChatGPT said: