This systematic review pools 9 studies and 239 total shoulder arthroplasties performed on B2 (biconcave) glenoids. It compares three techniques for correcting glenoid retroversion: asymmetric reaming, posterior bone-grafting, and posteriorly augmented glenoid components. The goal was to establish a baseline understanding of outcomes and complication rates for this difficult reconstructive problem.
When you see a biconcave B2 glenoid on preop CT, recognize that a standard glenoid implant will sit in retroversion and eccentrically load, which drives loosening and revision. The Walch classification is the framework: B2 means an eroded posterior neoglenoid plus a preserved anterior paleoglenoid, with more severe retroversion than B1 or C.
This review's practical message is that technique choice is a complication tradeoff, not a function tradeoff. Constant scores were similar across methods, but revision was 15.6% for reaming, 9.5% for grafting, and 0% for augmented components. Remember the 15-degree rule: reaming past that penetrates the vault and still may not fix posterior subluxation.
Weight the augmented glenoid result cautiously. Zero revisions is promising but follow-up was short and radiolucency rates were the highest of any group. In elderly low-demand patients, reverse arthroplasty is the fallback when bone stock and subluxation are concerns.
Total Shoulder B2glenoids
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This systematic review pools 9 studies and 239 total shoulder arthroplasties performed on B2 (biconcave) glenoids. It compares three techniques for correcting glenoid retroversion: asymmetric reaming, posterior bone-grafting, and posteriorly augmented glenoid components. The goal was to establish a baseline understanding of outcomes and complication rates for this difficult reconstructive problem.
When you see a biconcave B2 glenoid on preop CT, recognize that a standard glenoid implant will sit in retroversion and eccentrically load, which drives loosening and revision. The Walch classification is the framework: B2 means an eroded posterior neoglenoid plus a preserved anterior paleoglenoid, with more severe retroversion than B1 or C.
This review's practical message is that technique choice is a complication tradeoff, not a function tradeoff. Constant scores were similar across methods, but revision was 15.6% for reaming, 9.5% for grafting, and 0% for augmented components. Remember the 15-degree rule: reaming past that penetrates the vault and still may not fix posterior subluxation.
Weight the augmented glenoid result cautiously. Zero revisions is promising but follow-up was short and radiolucency rates were the highest of any group. In elderly low-demand patients, reverse arthroplasty is the fallback when bone stock and subluxation are concerns.