Our technique to treat a biconcave glenoid (severe B2 subtype) with reverse total shoulder arthroplasty corrects the humeral head subluxation and associated posterior glenoid bone loss, both of which are difficult to address with a conventional anatomic arthroplasty procedure.
Step 1: Preoperative Planning
Obtain a preoperative computed tomography (CT) scan and make a detailed preoperative plan for reaming and bone-grafting.
Step 2: Surgical Approach
Perform a standard deltopectoral approach.
Step 3: Humeral Preparation
Prepare the humerus in a way that allows you to retain the humeral head for bone-grafting, being careful not to make an overly conservative first cut that effectively splits the intended bone graft.
Step 4: Glenoid Exposure
Proper glenoid exposure is an essential element of this operation and even more difficult for the B2 glenoid than in a standard total shoulder replacement.
Step 5: Glenoid Preparation
Having adequately visualized the glenoid, ream the anterior aspect of the glenoid in a way that executes your preoperative plan; do not ream >1 cm.
Step 6: Glenoid Fixation
Use the screws to compress the bone graft between the metaglene and the native glenoid.
Step 7: Closure
Proceed with your standard closure.
We presented our results of this procedure in twenty-seven shoulders in twenty-seven patients with a mean duration of follow-up of fifty-four months (range, twenty-four to 139 months).
Pitfalls & Challenges