Total shoulder arthroplasty in patients with a B2 glenoid addressed with corrective reaming.

This study describes the short-term functional and radiographic outcomes after total shoulder arthroplasty (TSA) in shoulders with a B2 glenoid deformity addressed with corrective reaming. We conducted a retrospective series of consecutive patients who underwent TSA with a Walch B2 glenoid quantified by computed tomography scan. All glenoid deformities were addressed using partially corrective glenoid reaming. Radiographic and functional outcome measures, including scores on the visual analog scale for pain, American Shoulder and Elbow Standardized Shoulder Assessment, and Simple Shoulder Test were collected. Functional outcome scores were available for 59 of 92 eligible subjects (64%) at a mean of 50 months. The mean preoperative retroversion measured 18° (range, -1° to 36°), superior inclination was 8° (range, -11° to 27°), and posterior subluxation was 67% (range, 39%-91%). Mean visual analog scale improved from 7.4 to 1.4, the American Shoulder and Elbow Shoulder Standardized Assessment improved from 35.4 to 84.3, and the SST improved from 4.5 to 9.1. Radiographs were evaluated at a mean of 31 months: 38 had no glenoid radiolucent lines, 13 glenoids had grade 1, 2 had grade 2, and 5 had grade 3 lucencies. There was no difference in the rate of progression of glenoid radiolucencies between shoulders with a preoperative glenoid version of ≤20° (27.8%) compared with glenoids with >20° of retroversion (22.7%, P = .670). No shoulders were revised due to glenoid loosening or instability. TSA with partial corrective glenoid reaming in selected shoulders with a B2 glenoid deformity resulted in excellent functional and radiographic outcomes at short-term follow-up, with a low risk of revision surgery.

Orvets ND ，Chamberlain AM ，Patterson BM ，Chalmers PN ，Gosselin M ，Salazar D ，Aleem AW ，Keener JD ... -  《-》

Total shoulder arthroplasty in patients with a B2 glenoid addressed with corrective reaming: mean 8-year follow-up.

The management of Walch B2 glenoid deformities in primary glenohumeral osteoarthritis is frequently debated. Previous literature has shown that the treatment of B2 glenoids with high-side reaming and anatomic total shoulder arthroplasty (aTSA) perform well in the short-term but is associated with an increased glenoid component failure rate in severe deformities. Therefore, many have explored alternative options, including augmented anatomic glenoid components and reverse shoulder arthroplasty. Our goal in this study is to provide mid-term radiographic and clinical outcomes after high-side reaming and aTSA for B2 glenoids. Patients were followed both clinically and radiographically. Preoperative computed tomography scans were used for retrospective analysis of deformity. Both preoperative and postoperative visual analog scale pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test scores were collected. Radiographs were analyzed preoperatively and postoperatively for humeral head decentering relative to the glenoid vault, immediate glenoid seating, and final glenoid peg radiolucency. Of the original cohort of 59 patients (6 now deceased) reported at a mean radiographic follow-up of 3.4 years, 34 shoulders in 33 patients with B2 glenoids (mean retroversion 18.9°, range 4°-32°) were available for follow-up at a mean of 8.6 years (range 5.5-11.2) after high-side glenoid reaming with aTSA. Three (5.1%) of the original 59 shoulder were revised. At final follow-up, 3 of 30 (10.0%) shoulders had radiographic glenoid component failure, but were unrevised. Glenoid component failure was associated with worse initial glenoid component seating (mean Lazarus score 1.2 vs. 2.0, P = .002). Glenoid failure was also associated with increased posterior humeral head subluxation at 2-4 year follow-up (mean 5.6% vs. 12.6%, P = .045) and at final follow-up (mean 7.0% vs. 21%, P = .002). There was no association between glenoid component failure and preoperative retroversion, inclination, or humeral head subluxation (all P > .05). Glenoid component failure was associated with worse American Shoulder and Elbow Surgeons (88 vs. 73) and visual analog scale pain (0.8 vs. 2.1) scores (both P = .03). At a mean of 8.6 years, 88% of shoulders available for follow-up had well-fixed glenoid components. Glenoid component failure was associated with poor initial glenoid component seating, with failed components having an average of 25% of the glenoid component not seated. Preoperative deformity such as glenoid retroversion, inclination, or humeral head subluxation did not predict glenoid component failure. This study supports that initial glenoid component seating and recurrence of posterior humeral head subluxation may be the most important factors for mid-term glenoid component survival in aTSA in patients with B2 glenoids.

Harold RE ，Sweeney PT ，Torchia MT ，Chamberlain AM ，Keener JD ... -  《-》

Anatomic total shoulder arthroplasty for B2 glenoids treated with asymmetric reaming has equivalent survivorship and patient outcomes compared with type A glenoids at a mean 9-year follow-up.

Walch B2 glenoids can present a challenge to shoulder arthroplasty surgeons. Short-term studies have demonstrated that corrective reaming to 10° of retroversion in anatomic total shoulder arthroplasty (aTSA) can result in good outcomes; however, there is little data reporting the long-term outcomes in this cohort. B2 glenoids treated with high-side reaming present a theoretical risk of early glenoid component failure as one may ream into the subchondral bone. This study aimed to demonstrate that (1) B2 glenoids treated with corrective reaming have durable results and (2) offer similar results to Walch A1/2 in long-term follow-up. Patients who underwent aTSA by a single surgeon (E.L.F.) were identified from a shoulder arthroplasty registry. Inclusion criteria included Walch A1, A2, or B2 glenoid; a diagnosis of primary shoulder osteoarthritis; and a minimum radiographic and clinical follow-up of 5 years. Forty-three patients with B2 glenoids were compared to a cohort of 42 patients with A1 or A2 glenoids. Preoperative computed tomography (CT) and radiographs were used to assess deformity, glenoid version, and posterior subluxation of the humeral head. Postoperatively, patients were assessed with radiographs and patient-reported outcome measures including American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Simple Shoulder Test (SST) score, and visual analog scale (VAS). Eighty-five shoulders (82 patients, 42 B2 and 43 A1/A2 glenoids) with an average follow-up of 9.4 years were included. In the B2 cohort, the average retroversion was 21.1° and posterior subluxation was 69.4% compared with 10.6° (P < .001) and 57.5% (P < .001), respectively, in the A1 or A2 cohort. The cohort demographics were similar except for male sex (B2 69.8% vs. A1 or A2 37.2%, P = .008). There was no difference between the cohorts in their improvement in ASES (P = .807), SST (P = .586), and VAS (P = .930) scores. There was no difference in lateral humeral offset (P = .889) or acromial humeral interval (P = .468) between initial postoperative and final follow-up visits. Survivorship for B2 glenoids was 97.6%, 94.1%, and 73.3% at 5, 10, and 15 years, respectively, compared with 97.6%, 91.9%, and 83.5% in type A glenoids. The revision rate was similar between the 2 groups (P = .432). Lazarus score (P = .682) and rates of humeral radiolucency (P = .366) and humeral osteolysis (P = .194) were similar between the 2 cohorts at final follow-up. Asymmetric reaming of patients with B2 glenoids is a reliable method of glenoid preparation with excellent mid- to long-term clinical results, patient-reported outcomes, and low revision rates similar to their A1 and A2 counterparts.

Cirino CM ，Kantrowitz DE ，Boucher T ，Patel A ，Duey AH ，Cagle PJ ，Flatow EL ... -  《-》

Outcomes of anatomic shoulder arthroplasty performed on B2 vs. A1 type glenoids.

Glenoid component malpositioning and glenoid component retroversion have been associated with higher rates of radiolucencies, raising concerns about its implications on glenoid loosening and ultimate failure of anatomic total shoulder arthroplasty (TSA). Although there is literature regarding the relative advantages of techniques to address posterior glenoid bone loss, we are not aware of studies comparing outcomes of TSA on these challenging Walch type B2 glenoids vs. more common A1 glenoids. The purpose of this study is to compare outcomes of TSA performed on A1 glenoids and B2 glenoids treated with asymmetric glenoid reaming. We identified 1045 shoulders that had primary TSAs performed for osteoarthritis in a prospective shoulder arthroplasty registry. Two hundred eighty-nine shoulders met inclusion criteria of a preoperative Walch type A1 (178) or B2 (111) glenoid morphology, treatment with TSA, asymmetric reaming in the B2 group, and a minimum of 2-year clinical and radiographic follow-up. Postoperative radiographs were assessed for lucencies, and patient-reported outcome measures were collected at all follow-up visits. Follow-up averaged 40 ± 15 months for all patients, and more men presented with a B2 glenoid (80 of 111; 72%) compared with A1 (101 of 178; 57%) (P = .009). Age at surgery (P = .166), dominant-sided surgery (P = .281), body mass index (P = .501), smoking (P = .155), preoperative opioid use (P = .154), and diabetes (P = .331) were not significantly different between groups. Both groups had similar Constant Strength scores preoperatively (A1: 4.7 ± 7.1, and B2: 4.3 ± 7.3) but the B2 group improved significantly more at final follow-up (A1: 10.3 ± 6.2 vs. B2: 12.7 ± 6.7, P = .005). The Total Constant score was also significantly better at follow-up in the B2 glenoid group (P = .039). All other Constant subscales, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numerical Evaluation (SANE) measures showed significant improvement preoperatively to final follow-up (all P <.001) but there were no significant differences between the A1 and B2 glenoid groups (all P > .05). A similar proportion of patients rated their satisfaction as either very satisfied or satisfied between the A1 (160; 90%) and B2 (100; 90%) (P = .613). Lazarus scores were also similar between the A1 and B2 groups (P = .952) as were the rates of humeral radiolucent lines (P = .749) and humeral osteolysis (P = .507). Although patients with B2 glenoids may present a more technically challenging anatomic total shoulder arthroplasty, treatment with concurrent asymmetric glenoid reaming produced similar, successful clinical and radiographic early to midterm outcomes for patients undergoing TSA compared with A1 glenoids. Additional follow-up on this cohort will be important to confirm the durability of these early results.

Sheth MM ，Morris BJ ，Laughlin MS ，Cox JL ，Jones S ，Elkousy HA ，Edwards TB ... -  《-》

Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study.

Chen X ，Reddy AS ，Kontaxis A ，Choi DS ，Wright T ，Dines DM ，Warren RF ，Berhouet J ，Gulotta LV ... -  《-》