Anatomic or reverse total shoulder for posterior glenoid wear (B2) patterns?

The axillary "truth" view shown below was sent by an active 42 year old man from another state with young children and the desire to return to the gym and to play with his kids. We can agree that this film shows a posterior wear pattern. We can list a number of options for him to consider, including a ream and run, an anatomic total arthroplasty without changing glenoid version, anatomic total arthroplasty with high side (anterior) reaming, anatomic total arthroplasty with posterior bone graft, anatomic arthroplasty with a posteriorly augmented glenoid component, a reverse total shoulder without attempting to change glenoid version, a reverse total shoulder with "corrective" reaming and a reverse total shoulder with an augmented baseplate.

Is the literature helpful? A literature search found only a few articles published in the last 10 years comparing the outcomes for anatomic and reverse total shoulders in patients with posterior bone loss.

A comparative analysis of anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty for posterior glenoid wear patterns. The authors reviewed thirty-eight shoulders that underwent anatomic total shoulder (TSA) and 40 shoulders that underwent reverse total shoulder (RSA) with an average followup of 2 years.  The groups were not comparable. The RSA group included 27 males and 13 females with an average age of 71 years. The TSA group included 37 males and 1 female with an average age of 61 years. The mean ASES, SANE and VAS scores were not clinically significantly different for the two groups.

Total Shoulder Arthroplasty Versus Reverse Shoulder Arthroplasty in Primary Glenohumeral Osteoarthritis With Intact Rotator Cuffs: A Meta-Analyses Two hundred and forty-two glenoids were identified as Walch type B2. The groups were not comparable. The mean ages in the B2 subgroup were 68 and 73 years for the TSA and RSA groups. The percentages of males in the B2 subgroup were 75% and 47% for the TSA and RSA groups. The ASES and SANE scores  were not clinically significantly different.

Anatomic and reverse shoulder arthroplasty for management of type B2 and B3 glenoids: a matched-cohort analysis found that in patients with Walch type B2 or B3 glenoid morphology, primary RSA yielded short-term outcomes that were largely comparable to those of TSA. 

Anatomic shoulder arthroplasty with high side reaming versus reverse shoulder arthroplasty for eccentric glenoid wear patterns with an intact rotator cuff: comparing early versus midterm outcomes with minimum 7 years of follow-up reported the results shown below. The ASES and SST scores were not clinically significantly different at two year or at final followup (i.e. the differences did not exceed the minimal clinically important difference for either score).

Anatomic vs. reverse shoulder arthroplasty for the treatment of Walch B2 glenoid morphology: a systematic review and meta-analysis reported that in the setting of Walch B2 glenoid morphology, TSA with eccentric reaming or an augmented component yielded comparable outcomes to RSA. 

Some of these studies found that the revision rate in anatomic total shoulder arthroplasty with version correction was higher than for reverse total shoulder arthroplasty. This leads us to ask the questions: "is it important to correct glenoid version?" and "what are the potential adverse effects of glenoid version correction?". Here are some slides from a forthcoming presentation on this subject.

Comment: Almost half of patients having shoulder arthroplasty have wear of their posterior glenoid - "posterior wear is not rare". As described in the first paragraph of this post, there are at least 8 different surgical techniques that have been described. The selection among them depends on the expectations of the patient, the pathoanatomy of the shoulder and the familiarity and skill of the surgeon with the different alternatives.

Considering all of these factors, our choice for patients with shoulders having a posterior wear pattern is often an anatomic total shoulder arthroplasty with a standard (non-augmented) glenoid component well-seated on glenoid bone that is conservatively reamed without attempting to change version (see below).

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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).