The Bad B2 glenoid is frequently encountered in our arthroplasty practice. In a previous post I presented the two cases of quality of life limiting Bad B2 pathoanatomy below for thoughts on management. Options included reverse total shoulder, anatomic total shoulder without or with augmented glenoids or bone grafting, and various types of hemiarthroplasty.
Each patient was treated with the classic ream and run using an anteriorly eccentric humeral head to re-center the posteriorly unstable articulation. No preoperative CT scan or 3D planning were used in either case. The procedures were performed under general anesthesia without a plexus block. The long head tendon of the biceps was preserved in both cases. The subscapularis was peeled and repaired with six fiberwire sutures and a mild rotator interval closure.
Coincidentally, both patients returned for their two-year followups on the same day. Both reported the ability to perform each of the 12 functions of the Simple Shoulder Test. Both had strong subscapularis function.
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