Total shoulder arthroplasty for type B2 and B3 glenoid using standard glenoid components without version correction

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

These authors evaluated the ability of shoulder arthroplasty using a standard all-polyethylene 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.

They 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) score improved from 3.2 ± 2.1 points preoperatively to 9.9 ± 2.4 points

postoperatively 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 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 from preoperative glenoid version. 

The mean humeral-head decentering on the glenoid face was reduced for type-B2 glenoids from -14%  preoperatively to -1% postoperatively and for type-B3 glenoids from -4% preoperatively to -1% postoperatively.

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 (A1 - 67%, A2 - 85%, B1 - 74%, C - 75%).

The authors concluded that 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.

Another interesting aspect was the comparison of data from this study obtained with axillary x-rays to published data for CT scans for the typical glenoid version and decentering seen with different glenoid types.

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