Eleven years ago we met an 80 year old active man with painful stiff shoulder and the x-rays below, showing posterior decentering of the humeral head on a biconcave, retroverted B2 glenoid with posterior bone loss.
In many practices this situation would "automatically" lead to a reverse total shoulder. After discussion of the alternatives, this patient chose an anatomic total shoulder arthroplasty. Under general anesthesia, a standard glenoid component was inserted without attempting to change glenoid version. As expected, the central peg perforated the anterior glenoid wall. The standard humeral stem was fixed with impaction grafting. An anteriorly eccentric humeral head was used to control posterior translation.
At the age of 91, eleven years after his right anatomic total shoulder arthroplasty, he returned for evaluation of his contralateral shoulder. He reported unlimited painless function of his right shoulder, answered "yes" to all 12 questions of the Simple Shoulder Test, and had the x-rays shown below. The humeral and glenoid components are secure without evidence of radiolucent lines or stress shielding.
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Here are some videos that are of shoulder interest
