A robust approach to the B3 glenoid.

In Characterization of the Walch B3 glenoid in primary osteoarthritis the authors describe the B3 glenoid as uniconcave and retroverted with the humeral head concentrically centered in the uniconcave glenoid.

The question in managing a patient with a symptomatic B3 glenoid is whether it is important to attempt to "correct" the glenoid retroversion with bone graft or a posteriorly augmented (or "stepped") glenoid component.

The authors of Stepped Augmented Glenoid Component in Anatomic Total Shoulder Arthroplasty for B2 and B3 Glenoid Pathology: A Study of Early Outcomes point out that when attempting to restore "premorbid anatomy" in patients with moderate-to-severe B3 glenoid pathology using a stepped augmented glenoid component, there is a greater risk of central peg osteolysis (CPO) . CPO occurred in a higher percentage of B3 glenoids treated with the augmented glenoid component (29%) than A1 glenoids treated with a standard component (5%) (p = 0.028).

In addition, it is noted that substantial removal of posterior bone may be required to insert the augmented glenoid.

As explained in Standard total shoulder arthroplasty for arthritis with glenoid bone deficiency another option is to use a standard, non-augmented glenoid component inserted without attempting to modify glenoid version.

A third option in selected patients is to perform a ream and run arthroplasty without attempting to modify glenoid version, allowing the humeral head to remain centered in the uniconcave, retroverted glenoid.

Here is an example of a 70 year old very active man with a B3 glenoid.

Wishing to avoid the risks and limitations of a polyethylene glenoid component, he elected a ream and run procedure. At the time of surgery the glenoid was conservatively reamed - just enough to establish a smooth concentric joint surface - without attempt to change glenoid version. Humeral and glenoid bone stock was preserved. The procedure was performed without preoperative CT planning and without a brachial plexus block.

He started assisted motion the evening of surgery without narcotic medication. He was discharged the next day with 150 degrees of comfortable assisted motion.

Comment: Long term followup will determine which approach to the B3 glenoid produces the most durable outcomes.

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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).