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.
